Healthcare Provider Details

I. General information

NPI: 1326771247
Provider Name (Legal Business Name): PATRICIA J SCHULTZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S BROADBAND LN STE 107
SIOUX FALLS SD
57108-2261
US

IV. Provider business mailing address

5000 S BROADBAND LN STE 107
SIOUX FALLS SD
57108-2261
US

V. Phone/Fax

Practice location:
  • Phone: 605-275-2277
  • Fax:
Mailing address:
  • Phone: 605-275-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA J SCHULTZ
Title or Position: PSYCHOTHERAPIST
Credential: LPC-MH
Phone: 605-517-0578