Provider Demographics
NPI:1518491620
Name:TUCKER, ROBERT (LAADC, ICAADC, SAP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LAADC, ICAADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34670 CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-9318
Mailing Address - Country:US
Mailing Address - Phone:714-612-7197
Mailing Address - Fax:714-908-3308
Practice Address - Street 1:28481 RANCHO CALIFORNIA RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3667
Practice Address - Country:US
Practice Address - Phone:714-612-7197
Practice Address - Fax:714-908-3308
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR01580715101YA0400X, 101YP2500X
CACAWES1-1-011930SM101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral