MEDICARE: FELICIA TUCKER MSW, LSW

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	104100000X	Social Worker	4764-S	NV
2	1041C0700X	Clinical Social Worker
3	251B00000X	Case Management Agency
4	405300000X	Prevention Professional	4764-S	NV
5	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1427706464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA TUCKER MSW, LSW

Provider Business Mailing Address
First Line	:	7851 TORREYS PEAK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-5076
Country	:	US
Telephone Number	:	702-376-1444
Fax Number	:

Provider Business Practice Location Address
First Line	:	7851 TORREYS PEAK ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-5076
Country	:	US
Telephone Number	:	170-237-6144
Fax Number	:

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

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	06/03/2022

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