Provider Demographics
NPI:1578087367
Name:TUCKER, VANESSA A (LMFT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 SAWDUST RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2904
Mailing Address - Country:US
Mailing Address - Phone:281-319-4910
Mailing Address - Fax:832-663-9371
Practice Address - Street 1:1544 SAWDUST RD STE 102
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2904
Practice Address - Country:US
Practice Address - Phone:281-319-4910
Practice Address - Fax:832-663-9371
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202872101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty