MEDICARE: GLORIA ANNE LUCK

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	385HR2055X	Child Mental Illness Respite Care	2673854	AZ

General Provider Information

NPI Number	:	1417235094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA ANNE LUCK

Provider Business Mailing Address
First Line	:	10225 E DESERT EDEN PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5031
Country	:	US
Telephone Number	:	520-574-9454
Fax Number	:	520-296-8244

Provider Business Practice Location Address
First Line	:	10225 E DESERT EDEN PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5031
Country	:	US
Telephone Number	:	520-574-9454
Fax Number	:	520-296-8244

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

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	07/29/2011

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Directions to “ GLORIA ANNE LUCK ” Practice Location

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