Healthcare Provider Details

I. General information

NPI: 1871546002
Provider Name (Legal Business Name): MARIKAY STULTZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N. ENGLEWOOD DR.
CRAWFORDSVILLE IN
47933-9744
US

IV. Provider business mailing address

510 WAYNETOWN RD
CRAWFORDSVILLE IN
47933-1160
US

V. Phone/Fax

Practice location:
  • Phone: 765-361-9767
  • Fax: 765-361-0374
Mailing address:
  • Phone: 765-361-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34000086A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: