Healthcare Provider Details

I. General information

NPI: 1184588550
Provider Name (Legal Business Name): RAANNA TUCKER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 S EMERSON AVE STE H
INDIANAPOLIS IN
46237-8669
US

IV. Provider business mailing address

8344 LISMORE EAST DR APT D
INDIANAPOLIS IN
46227-9329
US

V. Phone/Fax

Practice location:
  • Phone: 317-801-3737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005811A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: