Healthcare Provider Details

I. General information

NPI: 1821184110
Provider Name (Legal Business Name): CLINICAL PSYCHOLOGY CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N FRANKLIN ST SUITE 230
VALPARAISO IN
46383
US

IV. Provider business mailing address

15 N FRANKLIN ST SUITE 230
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 Number
License Number StateIN

VIII. Authorized Official

Name: DR. DANIEL L. SCHULTZ
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 219-462-4770