Provider Demographics
NPI:1952501025
Name:OUTKA, NANCY M (LMFT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:OUTKA
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42395106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist