Healthcare Provider Details

I. General information

NPI: 1891211686
Provider Name (Legal Business Name): LEAH TUCKER MA, LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 ROYAL AVE
MONROE LA
71201-5724
US

IV. Provider business mailing address

1904 ROYAL AVE
MONROE LA
71201-5724
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6378
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1263
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: