Provider Demographics
NPI:1558051565
Name:GERHARDT, TUCKER DOUGLAS
Entity Type:Individual
Prefix:
First Name:TUCKER
Middle Name:DOUGLAS
Last Name:GERHARDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6653 N COLUMBIA WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-1806
Mailing Address - Country:US
Mailing Address - Phone:503-484-3587
Mailing Address - Fax:
Practice Address - Street 1:601 E MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3358
Practice Address - Country:US
Practice Address - Phone:360-281-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health