Healthcare Provider Details

I. General information

NPI: 1376369363
Provider Name (Legal Business Name): LOGAN SMITH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 ABBEY RD STE 200
EAST LANSING MI
48823-7302
US

IV. Provider business mailing address

1760 ABBEY RD STE 200
EAST LANSING MI
48823-7302
US

V. Phone/Fax

Practice location:
  • Phone: 615-763-5339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2400
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: