Provider Demographics
NPI:1336362748
Name:TUCKER, JUDITH K (MFT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:K
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MT DIABLO BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4852
Mailing Address - Country:US
Mailing Address - Phone:925-296-0245
Mailing Address - Fax:
Practice Address - Street 1:1200 MT DIABLO BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4852
Practice Address - Country:US
Practice Address - Phone:925-296-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33792174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist