Provider Demographics
NPI:1487850301
Name:TUCKER, ANGELA B (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:B
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FOUNTAINHALL CIR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-3401
Mailing Address - Country:US
Mailing Address - Phone:479-855-0493
Mailing Address - Fax:
Practice Address - Street 1:250 E CENTERTON BLVD
Practice Address - Street 2:YOUTH BRIDGE, INC.
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9240
Practice Address - Country:US
Practice Address - Phone:479-795-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0902013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional