Provider Demographics
NPI:1710479332
Name:TUCKER, LAURA MELTON (LMFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MELTON
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 1:2004 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-3238
Mailing Address - Country:US
Mailing Address - Phone:319-621-7244
Mailing Address - Fax:
Practice Address - Street 1:103 E COLLEGE ST STE 208
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4008
Practice Address - Country:US
Practice Address - Phone:319-359-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082722106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty