Provider Demographics
NPI:1447219910
Name:TUCKER, WILLIAM C (LMSW ACSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N MCCLELLAN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5710
Mailing Address - Country:US
Mailing Address - Phone:906-226-3556
Mailing Address - Fax:888-551-2613
Practice Address - Street 1:375 N MCCLELLAN AVE STE D
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5710
Practice Address - Country:US
Practice Address - Phone:906-226-3556
Practice Address - Fax:888-551-2613
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68010603441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N63680Medicare ID - Type Unspecified