Provider Demographics
NPI:1730485707
Name:LUDEMAN, TIM (LPC, MA)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:LUDEMAN
Suffix:
Gender:M
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 SE MONTEREY AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7725
Mailing Address - Country:US
Mailing Address - Phone:503-701-8839
Mailing Address - Fax:
Practice Address - Street 1:8305 SE MONTEREY AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7725
Practice Address - Country:US
Practice Address - Phone:503-701-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2972101YP2500X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health