Healthcare Provider Details

I. General information

NPI: 1578087367
Provider Name (Legal Business Name): VANESSA A TUCKER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 SAWDUST RD STE 102
SPRING TX
77380-2904
US

IV. Provider business mailing address

1544 SAWDUST RD STE 102
SPRING TX
77380-2904
US

V. Phone/Fax

Practice location:
  • Phone: 281-319-4910
  • Fax: 832-663-9371
Mailing address:
  • Phone: 281-319-4910
  • Fax: 832-663-9371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number202872
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: