Healthcare Provider Details

I. General information

NPI: 1114800158
Provider Name (Legal Business Name): MALIK TUCKER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 CYPRESSWOOD DR STE 175
SPRING TX
77379-7709
US

IV. Provider business mailing address

2086 PORTER RD APT 8304
CONROE TX
77301-5100
US

V. Phone/Fax

Practice location:
  • Phone: 713-510-4456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number93615
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: