Provider Demographics
NPI:1053891655
Name:TUCKER, JACINDA CELESTE (PHD)
Entity type:Individual
Prefix:DR
First Name:JACINDA
Middle Name:CELESTE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 NORTH LOOP W STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8013
Mailing Address - Country:US
Mailing Address - Phone:713-513-0467
Mailing Address - Fax:
Practice Address - Street 1:2180 NORTH LOOP W STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8013
Practice Address - Country:US
Practice Address - Phone:713-513-0467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37866103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty