Provider Demographics
NPI:1629402318
Name:NANCY M OUTKA LMFT
Entity Type:Organization
Organization Name:NANCY M OUTKA LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:OUTKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:510-657-7342
Mailing Address - Street 1:PO BOX 2102
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-0102
Mailing Address - Country:US
Mailing Address - Phone:510-505-9858
Mailing Address - Fax:510-505-9858
Practice Address - Street 1:39111 PASEO PADRE PARKWAY
Practice Address - Street 2:SUITE 203C
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1694
Practice Address - Country:US
Practice Address - Phone:510-505-9858
Practice Address - Fax:510-505-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42395106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty