MEDICARE: LEAH ELAINE 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	2022027092	MO

General Provider Information

NPI Number	:	1952164840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH ELAINE TUCKER

Provider Business Mailing Address
First Line	:	801 S WOODLAWN AVE STE 15
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-7647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 S WOODLAWN AVE
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-7646
Country	:	US
Telephone Number	:	636-379-1779
Fax Number	:

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

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

Similar Medicare Providers

1568159820 — JENNIFER CARROLL BA
Practice Location Address:

801 S WOODLAWN AVE
O FALLON, MO
63366-7646

Practice Phone: 636-379-1779
Practice Fax:

1194881870 — MS. ELIZABETH EATON MSW, LCSW
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801 S WOODLAWN , SUITE 29
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1467662338 — DR. BOBBI JEAN MILLER PH.D.
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1154593895 — DR. ROBIN ALLISON SWITZER ED.D. LPC
Practice Location Address:

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O FALLON, MO
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Practice Location Address:

801 S WOODLAWN , STE. 27
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1265929335 — BARRETT ENTERPRISE
Practice Location Address:

801 WOODLAWN AVE
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Directions to “ LEAH ELAINE TUCKER ” Practice Location

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