Provider Demographics
NPI:1386285161
Name:TEDDER, LOGAN (LPC)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:TEDDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MAGNOLIA AVE S STE 518
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2853
Mailing Address - Country:US
Mailing Address - Phone:205-251-7753
Mailing Address - Fax:205-251-7760
Practice Address - Street 1:303 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5709
Practice Address - Country:US
Practice Address - Phone:256-760-0200
Practice Address - Fax:256-760-0692
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4120OtherALABAMA BOARD OF EXAMINERS IN COUNSELING