Provider Demographics
NPI:1497009989
Name:TUCKER, ANN (NMI) (MA)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:(NMI)
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 N 70TH ST
Mailing Address - Street 2:#1
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6267
Mailing Address - Country:US
Mailing Address - Phone:602-402-0605
Mailing Address - Fax:
Practice Address - Street 1:4500 N 32ND ST
Practice Address - Street 2:SUITE 100-D
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3396
Practice Address - Country:US
Practice Address - Phone:602-402-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13370101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional