Basic Information
| Provider Information | |||||||||
| NPI: | 1053785584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | LICDC-CS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1090 W SOUTH BOUNDARY ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435515234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198738280 | ||||||||
| FaxNumber: | 4198738320 | ||||||||
| Practice Location | |||||||||
| Address1: | 1090 W SOUTH BOUNDARY ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435515234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198738280 | ||||||||
| FaxNumber: | 4198738320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2015 | ||||||||
| LastUpdateDate: | 11/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 933692 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.