MEDICARE: KAY ARDEN TUCKER

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	106H00000X	Marriage & Family Therapist	83821	CA

General Provider Information

NPI Number	:	1740674258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAY ARDEN TUCKER

Provider Business Mailing Address
First Line	:	1500 W EL CAMINO AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-1945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 AUBURN BLVD
Second Line	:	C208
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2069
Country	:	US
Telephone Number	:	916-300-6576
Fax Number	:

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

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	03/23/2015

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Directions to “ KAY ARDEN TUCKER ” Practice Location

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