Healthcare Provider Details

I. General information

NPI: 1770964975
Provider Name (Legal Business Name): DAVID C TUCKER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 10/09/2024
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MEDICAL CENTER PARKWAY
CLINTON AR
72031-1529
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-7888
  • Fax: 877-460-4576
Mailing address:
  • Phone: 870-448-5101
  • Fax: 870-448-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2011100
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: