Healthcare Provider Details

I. General information

NPI: 1992404164
Provider Name (Legal Business Name): HAILEY MARIE TUCKER MSSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 09/29/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 THUNDERSTICK DR STE 1104
LEXINGTON KY
40505-9009
US

IV. Provider business mailing address

315 TOWNEPARKE CIRCLE UNIT 101 AND B- 01
LOUISVILLE KY
40243
US

V. Phone/Fax

Practice location:
  • Phone: 859-254-1035
  • Fax: 859-254-2075
Mailing address:
  • Phone: 859-254-1035
  • Fax: 859-254-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001801
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: