Healthcare Provider Details

I. General information

NPI: 1497050165
Provider Name (Legal Business Name): AMANDA TUCKER MSCP, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 OAKVILLE DR APT TB
PITTSBURGH PA
15220-4322
US

IV. Provider business mailing address

340 OAKVILLE DR APT TB
PITTSBURGH PA
15220-4322
US

V. Phone/Fax

Practice location:
  • Phone: 412-552-0453
  • Fax:
Mailing address:
  • Phone: 412-552-0453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC005492
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: