Healthcare Provider Details

I. General information

NPI: 1588896765
Provider Name (Legal Business Name): RACHEL TUCKER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 COLLEGE AVENUE SUITE 314E
OAKLAND CA
94618-2529
US

IV. Provider business mailing address

PO BOX 20336
OAKLAND CA
94620-0336
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-3111
  • Fax:
Mailing address:
  • Phone: 510-205-0749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: