MEDICARE: ELIZABETH (LIBBY) ANN TUCKER LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	8461871	ID
2	101YM0800X	Mental Health Counselor	61228084	WA

General Provider Information

NPI Number	:	1184280414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH (LIBBY) ANN TUCKER LCPC

Provider Business Mailing Address
First Line	:	949 E 4TH AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-4096
Country	:	US
Telephone Number	:	208-723-9474
Fax Number	:

Provider Business Practice Location Address
First Line	:	949 E 4TH AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-4096
Country	:	US
Telephone Number	:	208-723-9474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	12/15/2025

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