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General NPI Number Information
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NPI Number | 1306501648
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Entity Type | Individual
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Provider Name | KYLE STEPHEN TUCKER LMSW
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Gender | Male
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 13975 WEST GRAND AVE #101
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City | SURPRISE
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State | AZ
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Zip | 85374
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Country | US
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Telephone | 623-266-8490
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Fax | 623-398-6094
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Provider Business Mailing Address
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Address Line | 650 E INDIAN SCHOOL RD
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City | PHOENIX
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State | AZ
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Zip | 85012-1839
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Country | US
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Telephone | 690-223-4712
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Fax | 602-217-1478
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-15716
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License Number State | AZ
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