Provider Demographics
NPI:1174337919
Name:GAMMON, BREANNA TUCK (LCSW)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:TUCK
Last Name:GAMMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:MICHELLE
Other - Last Name:TUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:13509 STAGE COACH LN
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:TX
Mailing Address - Zip Code:76035-4227
Mailing Address - Country:US
Mailing Address - Phone:817-932-0108
Mailing Address - Fax:
Practice Address - Street 1:13509 STAGE COACH LN
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:TX
Practice Address - Zip Code:76035-4227
Practice Address - Country:US
Practice Address - Phone:817-932-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical