KIMBERLY B TUCKER-PETTAY (NPI# 1588295620) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588295620 |
| Entity Type | Individual |
| Full Name | KIMBERLY B TUCKER-PETTAY |
| Credential | CT |
| Practice Address |
1711 Spring Ave Ne Canton OH 44714-2349 |
| Mailing Address |
625 Cleveland Ave Nw Canton OH 44702-1805 |
| Practice Telephone | 3304546800 |
| Practice Fax Number | 3305887176 |
| Mailing Telephone | 3304550374 |
| Mailing Fax Number | 3304536716 |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2020-01-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | C2002234TRNE | OH | Behavioral Health & Social Service Providers |
| Street Address |
1711 SPRING AVE NE |
| City | CANTON |
| State | OH |
| Zip Code | 44714-2349 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710936901 | Quest Recovery and Prevention Services | Substance Abuse Rehabilitation Facility | 1711 Spring Ave Ne, Canton, OH 44714-2349 | 2006-05-08 |
| 1508497561 | Melissa Nicole Saunders | Counselor | 1711 Spring Ave Ne, Canton, OH 44714-2349 | 2020-01-29 |
| 1760013874 | Tammy D Williams | Counselor | 1711 Spring Ave Ne, Canton, OH 44714-2349 | 2020-01-28 |
| 1144790940 | Jennifer Ann Bigrigg | Social Worker | 1711 Spring Ave Ne, Canton, OH 44714-2349 | 2018-12-05 |
| 1336626555 | Kristina Marie Zeren | Counselor | 1711 Spring Ave Ne, Canton, OH 44714-2349 | 2018-07-20 |
| 1164910451 | Therese Anne Sedon | Counselor | 1711 Spring Ave Ne, Canton, OH 44714-2349 | 2018-04-23 |
| 1790298172 | Breana R Mitchell | Counselor | 1711 Spring Ave Ne, Canton, OH 44714-2349 | 2017-11-08 |
| 1447790720 | Teresa Millard | Counselor | 1711 Spring Ave Ne, Canton, OH 44714-2349 | 2017-03-06 |
| 1780135780 | Dorette L Johnson | Counselor | 1711 Spring Ave Ne, Canton, OH 44714-2349 | 2016-10-14 |
| 1851759229 | Michelle M Smith | Counselor | 1711 Spring Ave Ne, Canton, OH 44714-2349 | 2016-02-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164941365 | Desiree Morgan | Occupational Therapy Assistant | 1634 20th St. N.e., Canton, OH 44714 | 2017-09-19 |
| 1932525706 | Cody Henninge | In Home Supportive Care | 2800 Market Ave N Suite 16, Canton, OH 44714 | 2014-03-17 |
| 1346584984 | Quest Recovery and Prevention Services | Substance Abuse Rehabilitation Facility | 1711 Spring Avenue Nw, Canton, OH 44714 | 2012-11-20 |
| 1780159921 | Lynne Marie Shayko | Counselor | 1341 Market Ave N, Canton, OH 44714 | 2018-10-03 |
| 1427437540 | Robert D Cox | Counselor | 1341 Market Ave N, Canton, OH 44714 | 2015-05-21 |
| 1225435969 | Emily A Custer | Counselor | 1341 Market Ave N, Canton, OH 44714 | 2014-11-24 |
| 1700438363 | Ryan Gernert | Specialist/Technologist | 5323 Gardendale Ave Ne, Canton, OH 44714-1042 | 2019-07-14 |
| 1982171468 | Adrienne Chavers | Home Health | 5438 Market Ave N, Canton, OH 44714-1059 | 2018-11-01 |
| 1912061797 | Living 4 Independence | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4629 Helmsworth Dr Ne, Canton, OH 44714-1162 | 2006-12-19 |
| 1114306412 | Haydee Thomas | Registered Nurse | 4611 Lindenwood Ave Ne, Canton, OH 44714-1169 | 2015-05-20 |
| Find all providers in zip 44714 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053888446 | Kerry Anne Minshew | Counselor | 42283 Highgate Ct, Canton, MI 48187-3523 | 2018-10-24 |
| 1285109132 | Rebekah Watkins LLC | Counselor | 2800 Market Ave N, Canton, OH 44714-1781 | 2018-10-08 |
| 1518432624 | Beverly Ann Tweedy | Counselor | 843 44th Street Nw, Unit #a, Canton, OH 45709-1647 | 2018-10-05 |
| 1811479009 | Linda Adams | Counselor | 2421 13th Street Nw, Canton, OH 44708 | 2018-09-04 |
| 1588146989 | Donna Gail Feinberg Rachwal | Counselor | 35 Shawmut Rd, Canton, MA 02021-1408 | 2018-08-31 |
| 1801373568 | Bethany Moulton | Counselor | 46972 Bartlett Dr, Canton, MI 48187-1409 | 2018-07-25 |
| 1255823555 | Sikeria Caldwell | Counselor | 7752 N Canton Center Rd, Canton, MI 48187-1328 | 2018-06-01 |
| 1922538099 | Heather Filippelli | Counselor | 43825 Michigan Ave # 1, Canton, MI 48188-2551 | 2017-06-12 |
| 1093166969 | Darnell Daniels | Counselor | 3395 Creeks Bend Ct, Canton, MI 48188-2386 | 2016-06-22 |
| 1609243419 | Eric Humble | Counselor | 359 Troy St, Canton, PA 17724-1015 | 2015-08-27 |
| Find all providers in CANTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.