Provider Demographics
NPI:1114054780
Name:TUCKER, MICHAEL LOVELL (LMSW,LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LOVELL
Last Name:TUCKER
Suffix:
Gender:
Credentials:LMSW,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8633 LAUDER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2421
Mailing Address - Country:US
Mailing Address - Phone:313-720-6702
Mailing Address - Fax:313-846-1975
Practice Address - Street 1:8633 LAUDER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2421
Practice Address - Country:US
Practice Address - Phone:313-720-6702
Practice Address - Fax:313-846-1975
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002813101YP2500X
MI68010656301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional