1871684845 NPI number — MRS. GAIL TUCKER MASSEY MED LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871684845 NPI number — MRS. GAIL TUCKER MASSEY MED LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASSEY
Provider First Name:
GAIL
Provider Middle Name:
TUCKER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MED LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THIBODEAU
Provider Other First Name:
GAIL
Provider Other Middle Name:
TUCKER
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MED LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871684845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7517 PEABODY DR
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:
78729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-586-1608
Provider Business Mailing Address Fax Number:
512-257-8015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 N MOPAC
Provider Second Line Business Practice Location Address:
#818
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-586-1608
Provider Business Practice Location Address Fax Number:
512-257-8015
Provider Enumeration Date:
09/27/2006

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: 101YP2500X , with the licence number:  09253 , 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)

  • Identifier: 6095LC . This is a "BCBS NUMBER" identifier . This identifiers is of the category "OTHER".




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