Provider Demographics
NPI:1497058663
Name:TUCKER, STEVEN D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:D
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NE 7TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1632
Mailing Address - Country:US
Mailing Address - Phone:541-450-7417
Mailing Address - Fax:
Practice Address - Street 1:777 NE 7TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1632
Practice Address - Country:US
Practice Address - Phone:541-450-7417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL27341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical