Provider Demographics
NPI:1043382807
Name:HERTZ, NANCY LYNN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:HERTZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 LAKE ST S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2639
Mailing Address - Country:US
Mailing Address - Phone:651-982-4792
Mailing Address - Fax:651-982-6035
Practice Address - Street 1:1068 LAKE ST S
Practice Address - Street 2:SUITE 109
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2639
Practice Address - Country:US
Practice Address - Phone:651-982-4792
Practice Address - Fax:651-982-6035
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1037106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist