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General NPI Number Information
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NPI Number | 1023379427
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Entity Type | Individual
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Provider Name | CHAMON LENORE TUCKER
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Gender | Female
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 1301 MARTIN LUTHER KING BLVD STE #101
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City | OKLAHOMA CITY
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State | OK
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Zip | 73117-4235
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Country | US
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Telephone | 405-424-0007
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Fax | 405-424-6507
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Provider Business Mailing Address
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Address Line | 2109 N PAGE AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73111-1853
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Country | US
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Telephone | 405-474-7031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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