Provider Demographics
NPI:1194073601
Name:TUCKER, JASON GLENN (LMHC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:GLENN
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 W. 15TH STREET,
Mailing Address - Street 2:FLORIDA THERAPY SERVICES,
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401
Mailing Address - Country:US
Mailing Address - Phone:850-545-5941
Mailing Address - Fax:
Practice Address - Street 1:2711 W. 15TH STREET,
Practice Address - Street 2:FLORIDA THERAPY SERVICES,
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401
Practice Address - Country:US
Practice Address - Phone:850-545-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor