Healthcare Provider Details

I. General information

NPI: 1245167238
Provider Name (Legal Business Name): KELLY MARIE TUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

685 NW 5TH ST STE A
CORVALLIS OR
97330-6462
US

IV. Provider business mailing address

34724 BREWSTER RD
LEBANON OR
97355-9432
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-1761
  • Fax:
Mailing address:
  • Phone: 218-428-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: