Provider Demographics
NPI:1003564055
Name:ANDY TUCKER LLC
Entity Type:Organization
Organization Name:ANDY TUCKER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-834-9411
Mailing Address - Street 1:616 N NORTH CT STE 150
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8121
Mailing Address - Country:US
Mailing Address - Phone:847-834-9411
Mailing Address - Fax:
Practice Address - Street 1:616 N NORTH CT STE 150
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8121
Practice Address - Country:US
Practice Address - Phone:847-834-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)