Provider Demographics
NPI:1972821395
Name:TUCKER, RENEE LIZABETH (LPCC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:LIZABETH
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 BROOKS AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3201
Mailing Address - Country:US
Mailing Address - Phone:651-338-4972
Mailing Address - Fax:651-641-0340
Practice Address - Street 1:1919 UNIVERSITY AVENUE WEST
Practice Address - Street 2:SUITE 6
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-338-4972
Practice Address - Fax:651-641-0340
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC 00156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional