Provider Demographics
NPI:1023984234
Name:HARTSOG, LOGAN MICHAEL
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:MICHAEL
Last Name:HARTSOG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5720
Mailing Address - Country:US
Mailing Address - Phone:304-573-6461
Mailing Address - Fax:304-573-6461
Practice Address - Street 1:102 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5720
Practice Address - Country:US
Practice Address - Phone:304-573-6461
Practice Address - Fax:304-573-6461
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009471751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical