Provider Demographics
NPI:1902068901
Name:RESNIKOFF, NANCY LEAH (LMFT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEAH
Last Name:RESNIKOFF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:LEAH
Other - Last Name:HATLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367
Mailing Address - Country:US
Mailing Address - Phone:925-550-0361
Mailing Address - Fax:
Practice Address - Street 1:7760 HIGHWAY 101 N
Practice Address - Street 2:
Practice Address - City:GLENEDEN BEACH
Practice Address - State:OR
Practice Address - Zip Code:97388
Practice Address - Country:US
Practice Address - Phone:925-550-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54505106H00000X
ORT1440106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist