| Doctor Name: | MRS. ANGELA B TUCKER |
| NPI Number: | 1487850301 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., L.P.C. |
| License Number: | P0902013 |
| Business Practice Address: | 250 E Centerton Blvd Youth Bridge, Inc. Centerton, AR - 727199240 |
| Business Phone Number: | 4797951802 |
| Business Fax Number: | |
| Mailing Address: | 2 Fountainhall Cir, BELLA VISTA |
| State: | AR |
| Postal Code: | 727153401 |
| Phone Number: | 4798550493 |
| Fax Number: | |
| NPI Enumeration Date: | 06/26/2007 |
| NPI Last Update Date: | 04/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | P0902013 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |