Healthcare Provider Details

I. General information

NPI: 1932223963
Provider Name (Legal Business Name): KAMA JOY SCHULTE M.A., L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W DIVERSEY PKWY STE 209
CHICAGO IL
60614-1682
US

IV. Provider business mailing address

PO BOX 577692
CHICAGO IL
60657-7692
US

V. Phone/Fax

Practice location:
  • Phone: 773-480-8579
  • Fax:
Mailing address:
  • Phone: 773-480-8579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180001327
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: