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General NPI Number Information
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NPI Number | 1386649622
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Entity Type | Individual
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Provider Name | GARY MICHAEL SCHULTHEIS LCSW, LMFT
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 3700 BELLEMEADE AVE STE 110
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City | EVANSVILLE
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State | IN
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Zip | 47714-0102
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Country | US
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Telephone | 812-477-2350
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Fax | 812-477-2378
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Provider Business Mailing Address
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Address Line | 3700 BELLEMEADE AVE STE 110
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City | EVANSVILLE
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State | IN
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Zip | 47714-0102
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Country | US
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Telephone | 812-477-2350
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Fax | 812-477-2378
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34002273A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35000058A
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License Number State | IN
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