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NPI Code Detail

MEDICARE: PAIGE TUCK LPC

MEDICARE:   PAIGE  TUCK  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
1101YM0800XMental Health Counselor2015043298MO

General Provider Information

NPI Number : 1487141040
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAIGE TUCK LPC
Provider Business Mailing Address
First Line : 3955 S FARM ROAD 223
Second Line :
City : ROGERSVILLE
State : MO
Zip : 65742-8807
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1717 E REPUBLIC RD STE D
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-6588
Country : US
Telephone Number : 417-351-4282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2018
Last Update Date : 04/19/2018

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Directions to “ PAIGE TUCK LPC” Practice Location

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