MR. LARRY JAMES TEDDER CDP NPI 1376823526

NPI Information

NPI: 1376823526
Provider Name: MR. LARRY JAMES TEDDER, CDP
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
305 PACIFIC AVE S STE 102
KELSO, WA
ZIP 98626
Phone: (360) 577-7442
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MR. Larry James Tedder, CDP is an addiction (substance use disorder) counselor in Kelso, WA. MR. Larry James Tedder, CDP NPI is 1376823526. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

305 PACIFIC AVE S STE 102
KELSO, WA
ZIP 98626-638
Phone: (360) 577-7442
Fax: (360) 577-7904

The enumeration date for this NPI number is 8/19/2011 and was last updated on 11/21/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	00001495	WASHINGTON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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