Provider Demographics
NPI:1467463182
Name:TUCKER, ANN (PH D)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 RICHLYNN TERRACE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76118-5119
Mailing Address - Country:US
Mailing Address - Phone:817-595-1177
Mailing Address - Fax:817-595-1177
Practice Address - Street 1:7055 RICHLYNN TERRACE
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76118-5119
Practice Address - Country:US
Practice Address - Phone:817-595-1177
Practice Address - Fax:817-595-1177
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20456 WITN HSP103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0403693Medicaid
00CF57Medicare ID - Type Unspecified