1821296930 NPI number — CAROLYN GAIL TUCKER RN., LCSW

Table of content: CAROLYN GAIL TUCKER RN., LCSW (NPI 1821296930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821296930 NPI number — CAROLYN GAIL TUCKER RN., LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUCKER
Provider First Name:
CAROLYN
Provider Middle Name:
GAIL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN., LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUCKER
Provider Other First Name:
CARY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN., LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1821296930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
512 E 40TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78751-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-451-5310
Provider Business Mailing Address Fax Number:
512-451-4750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100A W DEAN KEETON ST
Provider Second Line Business Practice Location Address:
1 UNIVERSITY STATION A3500
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78712-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-475-6940
Provider Business Practice Location Address Fax Number:
512-471-8875
Provider Enumeration Date:
07/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  36306 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)