Healthcare Provider Details

I. General information

NPI: 1699606624
Provider Name (Legal Business Name): LOGAN MICHAEL MURRAY LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 S MAIN ST STE 101
CLARKSTON MI
48346-2377
US

IV. Provider business mailing address

5980 S MAIN ST STE 101
CLARKSTON MI
48346-2377
US

V. Phone/Fax

Practice location:
  • Phone: 248-266-0920
  • Fax: 248-625-6829
Mailing address:
  • Phone: 248-266-0920
  • Fax: 248-625-6829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121858
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: