Provider Demographics
NPI:1043967615
Name:FLOTTMAN, TUCKER RICHARD (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:TUCKER
Middle Name:RICHARD
Last Name:FLOTTMAN
Suffix:
Gender:
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 BERNADETTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5007
Mailing Address - Country:US
Mailing Address - Phone:573-874-3777
Mailing Address - Fax:
Practice Address - Street 1:3037 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2602
Practice Address - Country:US
Practice Address - Phone:573-708-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MO2025005930103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician