Individual
BOONE MARTIN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2180 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4558
(805) 473-7081
Mailing address
2180 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4558
(805) 473-7081
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
RT1437960426
CA
225400000X
Rehabilitation Practitioner
Primary
—
CA
Other
Enumeration date
10/11/2022
Last updated
04/10/2026
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