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NPI Code Detail

MEDICARE: DR. CHRISTOPHER TUCKER EDD

MEDICARE: DR. CHRISTOPHER TUCKER EDD
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 Counselor5274048-6004UT

General Provider Information

NPI Number : 1902659089
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER TUCKER EDD
Provider Business Mailing Address
First Line : 912 E MONTANA VISTA LN
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-2467
Country : US
Telephone Number : 801-541-3068
Fax Number :
Provider Business Practice Location Address
First Line : 2825 E COTTONWOOD PKWY STE 500
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-7060
Country : US
Telephone Number : 646-941-7645
Fax Number : 929-596-7897
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2024
Last Update Date : 04/09/2024

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