Provider Demographics
NPI:1487813028
Name:TUCKER, MARY CATHERINE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHERINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 COLLEGE OF EDUCATION
Mailing Address - Street 2:INDIANA STATE UNIVERSITY
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47809-0001
Mailing Address - Country:US
Mailing Address - Phone:812-237-2889
Mailing Address - Fax:812-237-2729
Practice Address - Street 1:1511 COLLEGE OF EDUCATION
Practice Address - Street 2:INDIANA STATE UNIVERSITY
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47809-0001
Practice Address - Country:US
Practice Address - Phone:812-237-2889
Practice Address - Fax:812-237-2729
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional