Provider Demographics
NPI:1932828555
Name:TUCKER, CHASLYN EVE-ANMARIE (CSW)
Entity Type:Individual
Prefix:
First Name:CHASLYN
Middle Name:EVE-ANMARIE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PHILLIP STONE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1929
Mailing Address - Country:US
Mailing Address - Phone:866-934-4611
Mailing Address - Fax:
Practice Address - Street 1:222 PHILLIP STONE WAY
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1929
Practice Address - Country:US
Practice Address - Phone:866-934-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2566691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical