MEDICARE: SHELBY DAWN SCHULTZ LCSW

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	1041C0700X	Clinical Social Worker	BBH-LCSW-LIC-12101	MT

General Provider Information

NPI Number	:	1396124913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY DAWN SCHULTZ LCSW

Provider Business Mailing Address
First Line	:	PO BOX 12
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0012
Country	:	US
Telephone Number	:	406-777-5522
Fax Number	:	406-777-1175

Provider Business Practice Location Address
First Line	:	715 MAIN ST
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-2846
Country	:	US
Telephone Number	:	406-777-5522
Fax Number	:	406-777-1175

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

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	08/19/2021

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