Individual
JUSTINE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC, MHP
Contact information
Practice address
2003 SE WALTON BLVD, BENTONVILLE, AR 72712-3725
(479) 464-5925
(479) 464-4275
Mailing address
4171 N CROSSOVER RD, FAYETTEVILLE, AR 72703-4591
(479) 521-1427
(479) 521-6520
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A1601002
AR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/21/2013
Last updated
07/15/2016
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