Provider Demographics
NPI:1548380454
Name:TUCKER, GRETCHEN RENEE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:RENEE
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 1:1103 EMOREY CIR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-6202
Mailing Address - Country:US
Mailing Address - Phone:330-628-2936
Mailing Address - Fax:
Practice Address - Street 1:1369 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2611
Practice Address - Country:US
Practice Address - Phone:330-327-4935
Practice Address - Fax:330-454-0933
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 0601070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health