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NPI Code Detail

MEDICARE: NAOMI TUCKER LMFT

MEDICARE: NAOMI TUCKER LMFT
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
1106H00000XMarriage & Family TherapistMFC 44453CA

General Provider Information

NPI Number : 1578781530
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAOMI TUCKER LMFT
Provider Business Mailing Address
First Line : 12304 SANTA MONICA BLVD STE 327
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-7207
Country : US
Telephone Number : 310-795-8870
Fax Number :
Provider Business Practice Location Address
First Line : 12304 SANTA MONICA BLVD STE 327
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-7207
Country : US
Telephone Number : 310-795-8870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 08/16/2016

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