Healthcare Provider Details

I. General information

NPI: 1750744181
Provider Name (Legal Business Name): NANCY HUZICKA CREBS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 04/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 LAKE TAHOE BLVD STE 9
SOUTH LAKE TAHOE CA
96150-7920
US

IV. Provider business mailing address

PO BOX 7138
SOUTH LAKE TAHOE CA
96158-0138
US

V. Phone/Fax

Practice location:
  • Phone: 530-386-8386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number92420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: