Provider Demographics
NPI:1396105292
Name:TUCKER, AUTUMN (BSW)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1141 CHAPEL HILL CIR
Mailing Address - Street 2:
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080-4112
Mailing Address - Country:US
Mailing Address - Phone:615-574-8326
Mailing Address - Fax:
Practice Address - Street 1:1141 CHAPEL HILL CIR
Practice Address - Street 2:
Practice Address - City:JOELTON
Practice Address - State:TN
Practice Address - Zip Code:37080-4112
Practice Address - Country:US
Practice Address - Phone:615-574-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker