Provider Demographics
NPI:1003863887
Name:KREBS, LUCRETIA HYZY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LUCRETIA
Middle Name:HYZY
Last Name:KREBS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E EVERGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4289
Mailing Address - Country:US
Mailing Address - Phone:360-513-5572
Mailing Address - Fax:360-263-2681
Practice Address - Street 1:1701 E EVERGREEN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4289
Practice Address - Country:US
Practice Address - Phone:360-513-5572
Practice Address - Fax:360-263-2681
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0178461OtherL&I
WA7118847Medicaid
WA6029KROtherREGENCE
WA0178461OtherL&I