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General NPI Number Information
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NPI Number | 1083577258
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Entity Type | Individual
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Provider Name | STEPHEN TUCKER
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Gender | Male
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1514 N GREENVILLE AVE
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City | ALLEN
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State | TX
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Zip | 75002-1202
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Country | US
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Telephone | 214-240-6272
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Fax |
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Provider Business Mailing Address
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Address Line | 2742 PHILLIPS ST
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City | ANNA
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State | TX
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Zip | 75409-5876
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Country | US
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Telephone | 214-240-6272
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 204781
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License Number State | TX
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