Provider Demographics
NPI:1346393071
Name:TUCKER, MICHON KRISTI (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:MICHON
Middle Name:KRISTI
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10615 PERRIN BEITEL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3141
Mailing Address - Country:US
Mailing Address - Phone:210-710-8087
Mailing Address - Fax:
Practice Address - Street 1:10615 PERRIN BEITEL RD STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3141
Practice Address - Country:US
Practice Address - Phone:210-710-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154538602Medicaid
TX080101101OtherGROUP MEDICAID NUMBER