Provider Demographics
NPI:1407029671
Name:TUCKER, TAMMY MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MARIE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1350
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-1350
Mailing Address - Country:US
Mailing Address - Phone:714-225-8840
Mailing Address - Fax:
Practice Address - Street 1:6200 E CANYON RIM RD STE 215F
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4316
Practice Address - Country:US
Practice Address - Phone:714-225-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist