Healthcare Provider Details

I. General information

NPI: 1508325416
Provider Name (Legal Business Name): DAVID TUCKER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20121 LEADWELL ST UNIT 2
WINNETKA CA
91306-4918
US

IV. Provider business mailing address

108 W VICTORIA ST
GARDENA CA
90248-3523
US

V. Phone/Fax

Practice location:
  • Phone: 310-926-3536
  • Fax:
Mailing address:
  • Phone: 310-715-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: