Healthcare Provider Details

I. General information

NPI: 1154358059
Provider Name (Legal Business Name): JOHN C SHULTZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9080 LEAVITT RD
ELYRIA OH
44035
US

IV. Provider business mailing address

259 SANDUSKY ST
ASHLAND OH
44805
US

V. Phone/Fax

Practice location:
  • Phone: 440-986-2600
  • Fax: 440-986-2603
Mailing address:
  • Phone: 419-289-1876
  • Fax: 419-281-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3260
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3260
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: