Provider Demographics
NPI:1447330840
Name:TUCKER-LLOYD, IRIS SUE (LMSW, LPC)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:SUE
Last Name:TUCKER-LLOYD
Suffix:
Gender:F
Credentials:LMSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8031 TIREMAN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-3469
Mailing Address - Country:US
Mailing Address - Phone:313-579-9451
Mailing Address - Fax:313-526-5747
Practice Address - Street 1:2925 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4825
Practice Address - Country:US
Practice Address - Phone:313-396-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007866101Y00000X
MI68010653141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP23800010Medicare PIN
MIP37550001Medicare PIN