Healthcare Provider Details

I. General information

NPI: 1649419359
Provider Name (Legal Business Name): MARY KAY SCHULTZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY KAY HOUCK

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 WESTWOOD DR
SEDALIA MO
65301-2102
US

IV. Provider business mailing address

88 THUNDER RD
BUFFALO MO
65622-6406
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-4774
  • Fax: 660-826-1300
Mailing address:
  • Phone: 609-510-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL05482000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2014029933
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: