Provider Demographics
NPI:1457168015
Name:TUCKER, ASHLEY DANIELLE (MA, LPCC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:DANIELLE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MA, LPCC
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 234
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55801-0234
Mailing Address - Country:US
Mailing Address - Phone:651-243-2484
Mailing Address - Fax:
Practice Address - Street 1:4910 CONSTELLATION DR
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55127-2218
Practice Address - Country:US
Practice Address - Phone:651-243-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC04740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health