Provider Demographics
NPI:1861440125
Name:SCHULTZ, JOHN S (MA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3519
Mailing Address - Country:US
Mailing Address - Phone:970-589-4553
Mailing Address - Fax:970-241-4479
Practice Address - Street 1:940 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3519
Practice Address - Country:US
Practice Address - Phone:970-589-4553
Practice Address - Fax:970-241-4479
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional