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General NPI Number Information
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NPI Number | 1780553214
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Entity Type | Individual
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Provider Name | DAVID TUCKER
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Gender | Male
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 202 E WASHINGTON ST STE 602
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City | ANN ARBOR
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State | MI
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Zip | 48104-2012
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Country | US
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Telephone | 734-201-5832
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 E MINER RD
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City | CLEVELAND
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State | OH
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Zip | 44124-1701
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Country | US
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Telephone | 440-487-3815
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6451024451
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License Number State | MI
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