Provider Demographics
NPI:1568916369
Name:TUCKER, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:COOKE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:27403 YNEZ RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5603
Mailing Address - Country:US
Mailing Address - Phone:951-852-9805
Mailing Address - Fax:951-894-5744
Practice Address - Street 1:27403 YNEZ RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5603
Practice Address - Country:US
Practice Address - Phone:951-852-9805
Practice Address - Fax:951-894-5744
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional