Provider Demographics
NPI:1013018266
Name:COMPREHENSIVE BEHAVIORAL HEALTH CARE, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE BEHAVIORAL HEALTH CARE, INC.
Other - Org Name:LAWRENCE V. TUCKER, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-678-3127
Mailing Address - Street 1:1396 N WATERMAN AVE
Mailing Address - Street 2:SUITE #110
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5313
Mailing Address - Country:US
Mailing Address - Phone:800-678-3127
Mailing Address - Fax:800-929-8557
Practice Address - Street 1:1396 N WATERMAN AVE
Practice Address - Street 2:SUITE #110
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5313
Practice Address - Country:US
Practice Address - Phone:800-678-3127
Practice Address - Fax:800-929-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84067207QA0401X, 207QA0505X, 207QG0300X, 2084F0202X, 2084P0015X, 2084P0800X, 2084P0802X, 2084P0805X, 2084P2900X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty
Not Answered2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Not Answered2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
Not Answered2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI38963Medicare UPIN