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General NPI Number Information
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NPI Number | 1629402318
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Entity Type | Organization
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Legal Business Name | NANCY M OUTKA LMFT
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 39111 PASEO PADRE PARKWAY SUITE 203C
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City | FREMONT
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State | CA
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Zip | 94538-1694
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Country | US
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Telephone | 510-505-9858
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Fax | 510-505-9858
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Provider Business Mailing Address
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Address Line | PO BOX 2102
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City | FREMONT
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State | CA
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Zip | 94536-0102
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Country | US
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Telephone | 510-505-9858
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Fax | 510-505-9858
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Authorized Official
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Title or Position | MARRIAGE FAMILY THERAPIST
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Name | NANCY M OUTKA
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Credential | LMFT
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Telephone | 510-657-7342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC42395
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License Number State | CA
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