Provider Demographics
NPI:1598643157
Name:TUCKER, BRENNA
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:
Other - Last Name:MUEHLBACHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4921 CHARLENE CIR APT 3
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3545
Mailing Address - Country:US
Mailing Address - Phone:714-454-8677
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD STE 3001
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4300
Practice Address - Country:US
Practice Address - Phone:562-450-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist