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NPI Code Detail

MEDICARE: COLLEEN E MILLER-TUCKETT LCPC-C

MEDICARE: COLLEEN E MILLER-TUCKETT LCPC-C
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
1101YM0800XMental Health CounselorFL
2101YP2500XProfessional CounselorXL3662ME

General Provider Information

NPI Number : 1699076729
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN E MILLER-TUCKETT LCPC-C
Provider Business Mailing Address
First Line : 126 LITHIA PINECREST RD
Second Line :
City : BRANDON
State : FL
Zip : 33511-5347
Country : US
Telephone Number : 813-689-8828
Fax Number :
Provider Business Practice Location Address
First Line : 126 LITHIA PINECREST RD
Second Line :
City : BRANDON
State : FL
Zip : 33511-5347
Country : US
Telephone Number : 813-689-8828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2010
Last Update Date : 12/20/2019

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Directions to “ COLLEEN E MILLER-TUCKETT LCPC-C” Practice Location

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