Healthcare Provider Details

I. General information

NPI: 1659443216
Provider Name (Legal Business Name): JANICE HAUSER SCHULTZ PSYD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/04/2024
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N MAIN ST STE 240
PUEBLO CO
81003-3046
US

IV. Provider business mailing address

1507 WABASH AVE
PUEBLO CO
81004-3345
US

V. Phone/Fax

Practice location:
  • Phone: 719-250-5888
  • Fax: 855-775-0361
Mailing address:
  • Phone: 719-250-5888
  • Fax: 855-775-0361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1421
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: