Healthcare Provider Details

I. General information

NPI: 1245728237
Provider Name (Legal Business Name): KELLY JEAN TUCKER LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 ORANGE ST
ASHEVILLE NC
28801-2341
US

IV. Provider business mailing address

34 ORANGE ST
ASHEVILLE NC
28801-2341
US

V. Phone/Fax

Practice location:
  • Phone: 828-532-6717
  • Fax: 828-372-4684
Mailing address:
  • Phone: 828-532-6717
  • Fax: 828-372-4684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12729
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: