Healthcare Provider Details

I. General information

NPI: 1043967615
Provider Name (Legal Business Name): TUCKER RICHARD FLOTTMAN MA, BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3037 LEXINGTON AVE
CAPE GIRARDEAU MO
63701-2602
US

IV. Provider business mailing address

918 BERNADETTE DR
COLUMBIA MO
65203-5007
US

V. Phone/Fax

Practice location:
  • Phone: 573-708-7250
  • Fax:
Mailing address:
  • Phone: 573-874-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2025005930
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: