Healthcare Provider Details

I. General information

NPI: 1114992138
Provider Name (Legal Business Name): JUSTIN SCHULZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 W MISSISSIPPI AVE
LAKEWOOD CO
80226-4326
US

IV. Provider business mailing address

2185 BROADWAY
DENVER CO
80205-2534
US

V. Phone/Fax

Practice location:
  • Phone: 303-986-4511
  • Fax: 303-986-0828
Mailing address:
  • Phone: 303-296-2244
  • Fax: 303-296-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number603
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: