Provider Demographics
NPI:1821720574
Name:MONTGOMERY, LOGAN MARSHALL (MA, LMHC)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:MARSHALL
Last Name:MONTGOMERY
Suffix:
Gender:
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 BRENT CROSS
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2456
Mailing Address - Country:US
Mailing Address - Phone:812-767-2334
Mailing Address - Fax:
Practice Address - Street 1:2225 CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-4488
Practice Address - Country:US
Practice Address - Phone:812-767-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004989A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health