Individual
SUSAN C TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1800 IRVING PL, SHREVEPORT, LA 71101-4608
(318) 773-6453
Mailing address
250 CASH POINT RD # 17, BOSSIER CITY, LA 71111-6243
(318) 773-6453
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
817
LA
103TC0700X
Clinical Psychologist
Primary
817
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
09/03/2021
Last updated
05/10/2022
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