Provider Demographics
NPI:1770964975
Name:TUCKER, DAVID C (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5101
Mailing Address - Fax:870-448-3767
Practice Address - Street 1:465 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-1529
Practice Address - Country:US
Practice Address - Phone:501-745-7888
Practice Address - Fax:877-460-4576
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
ARP2011100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)