Provider Demographics
NPI:1306172903
Name:TUCKER, GLORIA JEAN
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 LENNOX AVE APT D
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1534
Mailing Address - Country:US
Mailing Address - Phone:661-900-6644
Mailing Address - Fax:
Practice Address - Street 1:1400 S UNION AVE STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-4179
Practice Address - Country:US
Practice Address - Phone:661-397-8775
Practice Address - Fax:661-869-1503
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health