Provider Demographics
NPI:1881235604
Name:HOGAN, MICHAEL RICHARD (LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:HOGAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HIMANGO RD
Mailing Address - Street 2:
Mailing Address - City:ESKO
Mailing Address - State:MN
Mailing Address - Zip Code:55733-9431
Mailing Address - Country:US
Mailing Address - Phone:218-340-4462
Mailing Address - Fax:
Practice Address - Street 1:2024 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-2053
Practice Address - Country:US
Practice Address - Phone:218-722-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist