Provider Demographics
NPI:1083447528
Name:ZAKOOR, LOGAN JOSHUA
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:JOSHUA
Last Name:ZAKOOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 S BANCROFT RD
Mailing Address - Street 2:
Mailing Address - City:MORRICE
Mailing Address - State:MI
Mailing Address - Zip Code:48857-8757
Mailing Address - Country:US
Mailing Address - Phone:989-251-6500
Mailing Address - Fax:
Practice Address - Street 1:201 MULHOLLAND ST FL 3
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7693
Practice Address - Country:US
Practice Address - Phone:989-895-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852094122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker