Provider Demographics
NPI:1023379427
Name:TUCKER, CHAMON LENORE
Entity Type:Individual
Prefix:
First Name:CHAMON
Middle Name:LENORE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 N PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-1853
Mailing Address - Country:US
Mailing Address - Phone:405-474-7031
Mailing Address - Fax:
Practice Address - Street 1:1301 MARTIN LUTHER KING BLVD
Practice Address - Street 2:STE #101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-4235
Practice Address - Country:US
Practice Address - Phone:405-424-0007
Practice Address - Fax:405-424-6507
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health