Provider Demographics
NPI:1427243419
Name:TUCK, BELINDA JEAN (LPC)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:JEAN
Last Name:TUCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W PEARL ST
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2410
Mailing Address - Country:US
Mailing Address - Phone:817-559-4589
Mailing Address - Fax:817-288-0700
Practice Address - Street 1:419 W PEARL ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2410
Practice Address - Country:US
Practice Address - Phone:817-559-4589
Practice Address - Fax:817-288-0700
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85191LOtherBLUE CROSS BLUE SHIELD