Provider Demographics
NPI:1760552210
Name:TUCKER, TRACEY (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 UNION ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5073
Mailing Address - Country:US
Mailing Address - Phone:603-828-5436
Mailing Address - Fax:
Practice Address - Street 1:495 UNION ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5073
Practice Address - Country:US
Practice Address - Phone:603-828-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health