MEDICARE: LYNSEY TUCKER LCSW

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	1041C0700X	Clinical Social Worker	63878	TX

General Provider Information

NPI Number	:	1285072462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNSEY TUCKER LCSW

Provider Business Mailing Address
First Line	:	1407 W ROSEWOOD AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-4530
Country	:	US
Telephone Number	:	865-696-6638
Fax Number	:

Provider Business Practice Location Address
First Line	:	1407 W ROSEWOOD AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-4530
Country	:	US
Telephone Number	:	865-696-6638
Fax Number	:

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

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	11/24/2020

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