Individual
SHELBY TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1824 S VAN BUREN ST, ENID, OK 73703-7903
(405) 230-1168
Mailing address
702 N GRAND ST, ENID, OK 73701-3221
(580) 234-3791
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
10939126
OK
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/28/2021
Last updated
04/24/2023
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