Provider Demographics
NPI:1154398543
Name:TUCKER, LAURIE ANN (RN LMHC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RN LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 NW 43 ST
Mailing Address - Street 2:SUITE 3 C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653
Mailing Address - Country:US
Mailing Address - Phone:352-375-3678
Mailing Address - Fax:352-332-8989
Practice Address - Street 1:6216 NW 43 ST
Practice Address - Street 2:SUITE 3 C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653
Practice Address - Country:US
Practice Address - Phone:352-375-3678
Practice Address - Fax:352-332-8989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMHC005029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health