Provider Information for 1114054780
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Mr. MICHAEL LOVELL TUCKER LMSW,LPC
Sex: Male
NPI: 1114054780
Last Updated: 2025-03-25
Certification Date: 2025-03-25
Certification Date: 2025-03-25
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1114054780 | ||||||||||||
| Enumeration Date | 2007-02-28 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 8633 LAUDER ST DETROIT, MI 48228-2421 United States Phone: 313-720-6702 | Fax:313-846-1975 | ||||||||||||
| Primary Practice Address | 8633 LAUDER ST DETROIT, MI 48228-2421 United States Phone: 313-720-6702 | Fax:313-846-1975 | ||||||||||||
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