Healthcare Provider Details

I. General information

NPI: 1346792850
Provider Name (Legal Business Name): TUCKER DAY REPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 FIRST ST
PARSONS WV
26287-1235
US

IV. Provider business mailing address

213 FIRST ST
PARSONS WV
26287-1235
US

V. Phone/Fax

Practice location:
  • Phone: 304-478-2833
  • Fax: 304-478-4473
Mailing address:
  • Phone: 304-478-2833
  • 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: DUSTIN LUZIER
Title or Position: DIRECTOR
Credential:
Phone: 304-478-2833