Individual
MR. CHARLES LEE TUCKER I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
12925 NE 59TH ST, SPENCER, OK 73084-8605
(405) 464-2922
Mailing address
12925 NE 59TH ST, SPENCER, OK 73084-8605
(405) 464-2922
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1225
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225
NPI
OK
01
—
1225
NPI
—
Enumeration date
09/29/2011
Last updated
09/29/2011
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