Provider Demographics
NPI:1619849239
Name:HAYWARD TUCKER, MELISSA ANN (SPIRITUAL COUNSELOR)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:HAYWARD TUCKER
Suffix:
Gender:F
Credentials:SPIRITUAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-1815
Mailing Address - Country:US
Mailing Address - Phone:310-482-1675
Mailing Address - Fax:310-820-9805
Practice Address - Street 1:1341 W 53RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-3436
Practice Address - Country:US
Practice Address - Phone:310-704-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral