| Doctor Name: | MR. PAUL TUCKER |
| NPI Number: | 1861574717 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 2063 |
| Business Practice Address: | 527 W 3rd St Konawa, OK - 74849 |
| Business Phone Number: | 5809253286 |
| Business Fax Number: | 5809252362 |
| Mailing Address: | 527 W 3rd St, Po Box 358 KONAWA |
| State: | OK |
| Postal Code: | 74849 |
| Phone Number: | 5809253286 |
| Fax Number: | 5809252362 |
| NPI Enumeration Date: | 10/19/2006 |
| NPI Last Update Date: | 04/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2063 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |