=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710609102
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON KAY STULTZ MA, MED, LMHCA, EDSP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2022
-----------------------------------------------------
Last Update Date | 11/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22722 29TH DR SE STE 153
-----------------------------------------------------
City | BOTHELL
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98021-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-215-9382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22722 29TH DR SE
-----------------------------------------------------
City | BOTHELL
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98021-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-215-9382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0008X
-----------------------------------------------------
Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
-----------------------------------------------------
License Number | 522320A
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 61477333
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------