Provider Demographics
NPI:1306501648
Name:TUCKER, KYLE STEPHEN (LMSW)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:STEPHEN
Last Name:TUCKER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:650 E INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1839
Mailing Address - Country:US
Mailing Address - Phone:690-223-4712
Mailing Address - Fax:602-217-1478
Practice Address - Street 1:13975 WEST GRAND AVE
Practice Address - Street 2:#101
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-266-8490
Practice Address - Fax:623-398-6094
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-15716104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker