Provider Demographics
NPI:1508620683
Name:TUCKER, SARAH (LLPC, MA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LLPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8749
Mailing Address - Country:US
Mailing Address - Phone:231-510-0166
Mailing Address - Fax:
Practice Address - Street 1:2604 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8749
Practice Address - Country:US
Practice Address - Phone:231-510-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty