Healthcare Provider Details

I. General information

NPI: 1043149552
Provider Name (Legal Business Name): TUCKER SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 COLUMBIA AVE W
BATTLE CREEK MI
49015-2848
US

IV. Provider business mailing address

138 CHERRY ST APT 1/2
BATTLE CREEK MI
49017-3936
US

V. Phone/Fax

Practice location:
  • Phone: 269-397-2234
  • Fax:
Mailing address:
  • Phone: 727-483-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851122216
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: