Healthcare Provider Details

I. General information

NPI: 1942636220
Provider Name (Legal Business Name): WOODY BUCHANAN SCHULDT LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463142 STATE ROAD 200
YULEE FL
32097-5554
US

IV. Provider business mailing address

2778 RIVERSIDE AVE
JACKSONVILLE FL
32205-8227
US

V. Phone/Fax

Practice location:
  • Phone: 904-225-8280
  • Fax: 904-225-8232
Mailing address:
  • Phone: 904-225-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: