Provider Demographics
NPI:1235447152
Name:TUCKER, PAUL NORMAN (MS, LADAC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:NORMAN
Last Name:TUCKER
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Gender:M
Credentials:MS, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9201 MONTGOMERY BLVD NE
Mailing Address - Street 2:BLDG 5
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2468
Mailing Address - Country:US
Mailing Address - Phone:505-217-1717
Mailing Address - Fax:505-213-0041
Practice Address - Street 1:9201 MONTGOMERY BLVD NE
Practice Address - Street 2:BLDG 5
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2468
Practice Address - Country:US
Practice Address - Phone:505-217-1717
Practice Address - Fax:505-213-0041
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM4416101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)