=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386285161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH LOGAN TEDDER LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2019
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1609 MOCKINGBIRD COURT, ST, B
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35630-7511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-320-7781
-----------------------------------------------------
Fax | 256-320-7776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1609 MOCKINGBIRD COURT, ST, B
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35630-7511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-320-7781
-----------------------------------------------------
Fax | 256-320-7776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 4120
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------