MEDICARE: RAYA TUCKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C.1901994	OH
2	390200000X	Student in an Organized Health Care Education/Training Program		OH
3	101YM0800X	Mental Health Counselor	E.2203085	OH

General Provider Information

NPI Number	:	1205327871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYA TUCKER

Provider Business Mailing Address
First Line	:	520 N CHESTNUT ST
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-2218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 E ERIE ST
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-3594
Country	:	US
Telephone Number	:	330-256-0337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2018
Last Update Date	:	06/12/2023

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Directions to “ RAYA TUCKER ” Practice Location

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