Healthcare Provider Details

I. General information

NPI: 1104707306
Provider Name (Legal Business Name): AUSTIN SCHULTZ LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 W GRAND AVE STE 6
PORT WASHINGTON WI
53074-2075
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 262-427-8905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12060-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: