Provider Demographics
NPI:1467961649
Name:TUCKER THERAPY
Entity Type:Organization
Organization Name:TUCKER THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC
Authorized Official - Phone:814-335-2210
Mailing Address - Street 1:10066 STATE PARK RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15849-1136
Mailing Address - Country:US
Mailing Address - Phone:814-335-2210
Mailing Address - Fax:
Practice Address - Street 1:10066 STATE PARK RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:PA
Practice Address - Zip Code:15849-1136
Practice Address - Country:US
Practice Address - Phone:814-335-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty