MEDICARE: JENNIFER LEIGH TUCKER M.S, LPC

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	101Y00000X	Counselor	72503	TX
2	101YP2500X	Professional Counselor	72503	TX
3	106H00000X	Marriage & Family Therapist	72503	TX
4	101YM0800X	Mental Health Counselor	72503	TX

General Provider Information

NPI Number	:	1225573538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEIGH TUCKER M.S, LPC

Provider Business Mailing Address
First Line	:	20707 KEEGANS LEDGE LN
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-7727
Country	:	US
Telephone Number	:	281-826-9171
Fax Number	:

Provider Business Practice Location Address
First Line	:	14525 FM 529 RD STE 104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3596
Country	:	US
Telephone Number	:	281-826-9171
Fax Number	:	281-301-7799

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

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	04/02/2022

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