MEDICARE: MS. IRIS SUE TUCKER-LLOYD LMSW, LPC

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	101Y00000X	Counselor	6401007866	MI
2	1041C0700X	Clinical Social Worker	6801065314	MI

General Provider Information

NPI Number	:	1447330840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRIS SUE TUCKER-LLOYD LMSW, LPC

Provider Business Mailing Address
First Line	:	8031 TIREMAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-3469
Country	:	US
Telephone Number	:	313-579-9451
Fax Number	:	313-526-5747

Provider Business Practice Location Address
First Line	:	2925 RUSSELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-4825
Country	:	US
Telephone Number	:	313-396-5300
Fax Number	:

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	06/11/2024

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