Provider Demographics
NPI:1952590812
Name:TUCKER, SANDY KAY (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:KAY
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS, LMHC
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 52
Mailing Address - Street 2:
Mailing Address - City:CLEAR CREEK
Mailing Address - State:IN
Mailing Address - Zip Code:47426-0052
Mailing Address - Country:US
Mailing Address - Phone:812-219-4918
Mailing Address - Fax:
Practice Address - Street 1:4384 S DARRELL DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-9305
Practice Address - Country:US
Practice Address - Phone:812-219-4918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002332A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health