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General NPI Number Information
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NPI Number | 1447376348
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Entity Type | Individual
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Provider Name | MARVIN LEROY LOGEL PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 01/12/2025
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Provider Practice Location Address
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Address Line | 5200 WILLSON RD STE 150
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City | EDINA
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State | MN
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Zip | 55424-1300
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Country | US
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Telephone | 952-221-7166
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Fax | 952-937-0925
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Provider Business Mailing Address
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Address Line | 301 ALTARA AVE APT 519
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City | CORAL GABLES
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State | FL
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Zip | 33146-1465
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Country | US
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Telephone | 952-221-7166
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Fax | 952-937-0925
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP0569
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY7902
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7902
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number | PY7902
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number | LP0569
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License Number State | MN
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Taxonomy #6
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP0569
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License Number State | MN
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