Healthcare Provider Details

I. General information

NPI: 1356347710
Provider Name (Legal Business Name): DANIEL L. SCHULTZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

15 N FRANKLIN ST. CLINICAL PSYCHOLOGY CENTER PC
VALPARAISO IN
46383
US

IV. Provider business mailing address

15 N FRANKLIN ST. SUITE 230 CLINICAL PSYCHOLOGY CENTER PC
VALPARAISO IN
46383
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-4770
  • Fax: 219-464-8156
Mailing address:
  • Phone: 219-462-4770
  • Fax: 219-464-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20010329A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20010329
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: