Provider Demographics
NPI:1912760430
Name:MICHON TUCKER
Entity Type:Organization
Organization Name:MICHON TUCKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC-S
Authorized Official - Prefix:
Authorized Official - First Name:MICHON
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-710-8087
Mailing Address - Street 1:10615 PERRIN BEITEL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3141
Mailing Address - Country:US
Mailing Address - Phone:210-710-8087
Mailing Address - Fax:877-475-2397
Practice Address - Street 1:10615 PERRIN BEITEL RD STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3141
Practice Address - Country:US
Practice Address - Phone:210-710-8087
Practice Address - Fax:877-475-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty