Provider Demographics
NPI:1568672020
Name:TUCKER, HEIDI ANN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ANN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S SOWELL ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4658
Mailing Address - Country:US
Mailing Address - Phone:559-749-0203
Mailing Address - Fax:
Practice Address - Street 1:113 N CHURCH ST STE 421
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6300
Practice Address - Country:US
Practice Address - Phone:209-769-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41263106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist