MEDICARE: LOGAN SOLBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	AMFT152860	CA

General Provider Information

NPI Number	:	1942168455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN SOLBERG

Provider Business Mailing Address
First Line	:	1014 BROADWAY # 416
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2808
Country	:	US
Telephone Number	:	213-460-8706
Fax Number	:

Provider Business Practice Location Address
First Line	:	12381 WILSHIRE BLVD STE 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1063
Country	:	US
Telephone Number	:	617-765-9404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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Directions to “ LOGAN SOLBERG ” Practice Location

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