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General NPI Number Information
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NPI Number | 1073810644
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Entity Type | Organization
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Legal Business Name | KIM LOGAN COMMUNICATIONS CLINIC INC
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 3011 W GRAND BLVD SUITE 423
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City | DETROIT
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State | MI
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Zip | 48202-3096
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Country | US
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Telephone | 313-664-4900
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Fax | 313-664-4901
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Provider Business Mailing Address
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Address Line | 3011 W GRAND BLVD SUITE 423
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City | DETROIT
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State | MI
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Zip | 48202-3096
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Country | US
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Telephone | 313-664-4900
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Fax | 313-664-4901
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KAREN O ANDERSON
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Credential |
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Telephone | 313-664-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301011558
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801068236
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 6301011558
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License Number State | MI
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Taxonomy #8
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12068248
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License Number State | MD
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Taxonomy #10
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401001940
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License Number State | MI
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