MEDICARE: JACQUELINE SCHULD MS, LAC, ATR-P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LAC-19172	AZ

General Provider Information

NPI Number	:	1043981210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SCHULD MS, LAC, ATR-P

Provider Business Mailing Address
First Line	:	326 S WILMOT RD STE B230
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-4053
Country	:	US
Telephone Number	:	520-222-7525
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 S WILMOT RD STE B230
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-4053
Country	:	US
Telephone Number	:	520-222-7525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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