Individual
JAKE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
112 12TH AVE RD, NAMPA, ID 83686-5011
(208) 989-0907
Mailing address
112 12TH AVE RD, NAMPA, ID 83686-5011
(208) 989-0907
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-5669
ID
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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