Provider Demographics
NPI:1669185740
Name:TUCKER, JULIA MARIE (CMHC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 W SHASTA CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-8004
Mailing Address - Country:US
Mailing Address - Phone:801-971-1705
Mailing Address - Fax:
Practice Address - Street 1:9192 S 300 W STE 31
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2634
Practice Address - Country:US
Practice Address - Phone:801-895-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11993331-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health