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NPI Code Detail

MEDICARE: DAVID C TUCKER LPC

MEDICARE: DAVID C TUCKER 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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YP2500XProfessional CounselorP2011100AR

General Provider Information

NPI Number : 1770964975
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID C TUCKER LPC
Provider Business Mailing Address
First Line : PO BOX 1060
Second Line :
City : MARSHALL
State : AR
Zip : 72650-1060
Country : US
Telephone Number : 870-448-5101
Fax Number : 870-448-3767
Provider Business Practice Location Address
First Line : 465 MEDICAL CENTER PARKWAY
Second Line :
City : CLINTON
State : AR
Zip : 72031-1529
Country : US
Telephone Number : 501-745-7888
Fax Number : 877-460-4576
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2015
Last Update Date : 10/09/2024

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