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General NPI Number Information
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NPI Number | 1639520786
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Entity Type | Individual
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Provider Name | ANGELIQUE TRYNELL SCHULTZ MS, MA, LADC
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Gender | Female
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 476 MAIN ST
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City | WINOOSKI
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State | VT
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Zip | 05404-1300
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Country | US
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Telephone | 802-343-5499
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Fax |
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Provider Business Mailing Address
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Address Line | 537 KELLOGG RD # 2
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City | SAINT ALBANS
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State | VT
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Zip | 05478-7047
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Country | US
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Telephone | 802-343-5499
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 068.0126464
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 00714
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License Number State | VT
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