MEDICARE: MS. NANCY HOLBERT

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891045142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY HOLBERT

Provider Business Mailing Address
First Line	:	6457 TEPPER PARK WAY NE
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-1186
Country	:	US
Telephone Number	:	503-545-2706
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 EDGEWATER ST NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-4049
Country	:	US
Telephone Number	:	503-503-5885
Fax Number	:

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	02/15/2026

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