Provider Demographics
NPI:1346337268
Name:TUCKER, GEORGE HERMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HERMAN
Last Name:TUCKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30881 VIA ULTIMO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1760
Mailing Address - Country:US
Mailing Address - Phone:714-940-3918
Mailing Address - Fax:714-704-8803
Practice Address - Street 1:744 N ECKHOFF ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1006
Practice Address - Country:US
Practice Address - Phone:714-940-3918
Practice Address - Fax:714-704-8803
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical