Provider Demographics
NPI:1205602927
Name:TUCKER, ROBERT ANDREW (LMFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 THIELEN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-9613
Mailing Address - Country:US
Mailing Address - Phone:763-515-4563
Mailing Address - Fax:
Practice Address - Street 1:703 THIELEN DR
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-9613
Practice Address - Country:US
Practice Address - Phone:763-515-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist