Healthcare Provider Details

I. General information

NPI: 1922927474
Provider Name (Legal Business Name): JOSHUA SHULTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 MINNESOTA ST STE 1500
SAINT PAUL MN
55101-2269
US

IV. Provider business mailing address

PO BOX 206
LITTLE FALLS MN
56345-0206
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 218-302-5154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5738
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: