Healthcare Provider Details

I. General information

NPI: 1992061691
Provider Name (Legal Business Name): CHELSEA CARSON SCHULZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6206 IOLA AVE SUITE 109
LUBBOCK TX
75604
US

IV. Provider business mailing address

5316 TRAIL LAKE DR
FORT WORTH TX
76133-1931
US

V. Phone/Fax

Practice location:
  • Phone: 817-292-8787
  • Fax: 817-789-6849
Mailing address:
  • Phone: 817-292-8787
  • Fax: 817-789-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDT82033
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: