Provider Demographics
NPI:1396115598
Name:TUCKER, THOMAS RAND (MSW, PHD, LICSW)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RAND
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MSW, PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DECATUR AVE N
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4367
Mailing Address - Country:US
Mailing Address - Phone:763-746-2419
Mailing Address - Fax:763-746-2401
Practice Address - Street 1:701 DECATUR AVE N
Practice Address - Street 2:SUITE 109
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4367
Practice Address - Country:US
Practice Address - Phone:763-746-2419
Practice Address - Fax:763-746-2401
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN224651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical