Healthcare Provider Details

I. General information

NPI: 1275474348
Provider Name (Legal Business Name): CHRISTINE MICHELLE TUCKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 HARBOR BLVD STE 110 # 498
OXNARD CA
93035
US

IV. Provider business mailing address

3600 HARBOR BLVD STE 110 # 498
OXNARD CA
93035
US

V. Phone/Fax

Practice location:
  • Phone: 805-368-0433
  • Fax:
Mailing address:
  • Phone: 805-368-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW123311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: