Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1530 | LA |
Y | 103TC0700X | Clinical Psychologist | 1530 | LA |
NPI | 1003446873 |
---|---|
Provider Name | Dr. Raymond Tucker |
First Address | Baton Rouge, LA 70802-5934 |
Second Address | Baton Rouge, LA 70808-4375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2020 |
Last Update Date | 21/01/2020 |