MEDICARE: NANCY HUZICKA CREBS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	92420	CA

General Provider Information

NPI Number	:	1750744181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY HUZICKA CREBS LMFT

Provider Business Mailing Address
First Line	:	PO BOX 7138
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96158-0138
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3351 LAKE TAHOE BLVD STE 9
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-7920
Country	:	US
Telephone Number	:	530-386-8386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2016
Last Update Date	:	04/02/2016

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