Provider Demographics
NPI:1144943366
Name:MCGAHAN, CONNOR LOGAN (LLMSW)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:LOGAN
Last Name:MCGAHAN
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 COURT ST STE B
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2358
Mailing Address - Country:US
Mailing Address - Phone:989-572-0246
Mailing Address - Fax:
Practice Address - Street 1:210 COURT ST STE B
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2358
Practice Address - Country:US
Practice Address - Phone:989-572-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511155521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical