Provider Demographics
NPI:1497050165
Name:TUCKER, AMANDA (MSCP, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MSCP, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 ROSELAWN AVE
Mailing Address - Street 2:APT 7
Mailing Address - City:MT LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2235
Mailing Address - Country:US
Mailing Address - Phone:412-552-0453
Mailing Address - Fax:
Practice Address - Street 1:714 ROSELAWN AVE
Practice Address - Street 2:APT 7
Practice Address - City:MT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-2235
Practice Address - Country:US
Practice Address - Phone:412-552-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005492101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional