Provider Demographics
NPI:1235582719
Name:TUCKER, MILDRED CASSANDRA (MS, PLMHP, LADC)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:CASSANDRA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS, PLMHP, LADC
Other - Prefix:
Other - First Name:MILDRED
Other - Middle Name:CASSANDRA
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,PLMHP, LADC
Mailing Address - Street 1:1941 S 42ND ST STE 307
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2939
Mailing Address - Country:US
Mailing Address - Phone:402-979-8350
Mailing Address - Fax:888-490-0210
Practice Address - Street 1:1941 S 42ND ST STE 307
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-970-8350
Practice Address - Fax:888-490-0210
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1408101YA0400X
NE12709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026379900Medicaid