Healthcare Provider Details

I. General information

NPI: 1386649622
Provider Name (Legal Business Name): GARY MICHAEL SCHULTHEIS LCSW, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 BELLEMEADE AVE STE 110
EVANSVILLE IN
47714-0102
US

IV. Provider business mailing address

3700 BELLEMEADE AVE STE 110
EVANSVILLE IN
47714-0102
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-2350
  • Fax: 812-477-2378
Mailing address:
  • Phone: 812-477-2350
  • Fax: 812-477-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002273A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000058A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: