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General NPI Number Information
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NPI Number | 1235695867
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Entity Type | Organization
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Legal Business Name | SANDRA K. TUCKER, MS, LMHC, LLC
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 822 W 1ST ST STE 4
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2382
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Country | US
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Telephone | 812-219-4918
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Fax |
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Provider Business Mailing Address
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Address Line | 822 W 1ST ST STE 4
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2382
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Country | US
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Telephone | 812-219-4918
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Fax | 888-544-9038
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Authorized Official
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Title or Position | OWNER
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Name | SANDY K. TUCKER
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Credential | LMHC, RPT
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Telephone | 812-219-4918
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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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