Provider Demographics
NPI:1841971207
Name:TUCKER, BREANA (LMSW)
Entity type:Individual
Prefix:
First Name:BREANA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10541 SONDRA CT
Mailing Address - Street 2:
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-4122
Mailing Address - Country:US
Mailing Address - Phone:316-648-7259
Mailing Address - Fax:
Practice Address - Street 1:8080 E CENTRAL AVE STE 320
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2389
Practice Address - Country:US
Practice Address - Phone:316-927-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker