MEDICARE: KYLE SCHULTZ PSYD LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1972363315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KYLE SCHULTZ PSYD LLC

Provider Business Mailing Address
First Line	:	1420 WALNUT ST STE 1207
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4012
Country	:	US
Telephone Number	:	267-225-5605
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 WALNUT ST STE 1207
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4012
Country	:	US
Telephone Number	:	267-225-5605
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KYLE J SCHULTZ
Credential	:	PSYD
Telephone Number	:	315-532-2452

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	03/21/2024

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