Provider Demographics
NPI:1346792850
Name:TUCKER DAY REPORT CENTER
Entity Type:Organization
Organization Name:TUCKER DAY REPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-478-2833
Mailing Address - Street 1:213 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:WV
Mailing Address - Zip Code:26287-1235
Mailing Address - Country:US
Mailing Address - Phone:304-478-2833
Mailing Address - Fax:
Practice Address - Street 1:213 FIRST ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-1235
Practice Address - Country:US
Practice Address - Phone:304-478-2833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty