Provider Demographics
NPI:1386285161
Name:TEDDER, ELIZABETH LOGAN (LPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOGAN
Last Name:TEDDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:
Other - Last Name:TEDDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1609 MOCKINGBIRD COURT, ST, B
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-7511
Mailing Address - Country:US
Mailing Address - Phone:256-320-7781
Mailing Address - Fax:256-320-7776
Practice Address - Street 1:1609 MOCKINGBIRD COURT, ST, B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-7511
Practice Address - Country:US
Practice Address - Phone:256-320-7781
Practice Address - Fax:256-320-7776
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2025-10-28
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