Healthcare Provider Details

I. General information

NPI: 1679606222
Provider Name (Legal Business Name): MS. YVETTE DENISE TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MOTOR AVE
LOS ANGELES CA
90034-3710
US

IV. Provider business mailing address

13947 PARAMOUNT BLVD APT 206
PARAMOUNT CA
90723-2684
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-1223
  • Fax: 310-837-6647
Mailing address:
  • Phone: 310-836-1223
  • Fax: 310-837-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW63938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: