Provider Demographics
NPI:1588005060
Name:TUCKER, MARNEL KAE (PSYD)
Entity Type:Individual
Prefix:MISS
First Name:MARNEL
Middle Name:KAE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARNEL
Other - Middle Name:KAE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:4237 PALO VERDE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-3219
Mailing Address - Country:US
Mailing Address - Phone:562-833-3238
Mailing Address - Fax:
Practice Address - Street 1:4237 PALO VERDE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-3219
Practice Address - Country:US
Practice Address - Phone:562-833-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical