Healthcare Provider Details

I. General information

NPI: 1134069727
Provider Name (Legal Business Name): ASHLEY AZRA TUCIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E WEDDELL DR UNIT 4209
SUNNYVALE CA
94089-2373
US

IV. Provider business mailing address

550 E WEDDELL DR UNIT 4209
SUNNYVALE CA
94089-2373
US

V. Phone/Fax

Practice location:
  • Phone: 816-600-0354
  • Fax:
Mailing address:
  • Phone: 816-600-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number164755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: