Provider Demographics
NPI:1063839595
Name:MONTY SHULTZ COUNSELING & NEUROFEEDBACK LLC
Entity Type:Organization
Organization Name:MONTY SHULTZ COUNSELING & NEUROFEEDBACK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:308-627-6119
Mailing Address - Street 1:1101 E ELK TRL
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-8337
Mailing Address - Country:US
Mailing Address - Phone:308-627-4743
Mailing Address - Fax:
Practice Address - Street 1:2002 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-5302
Practice Address - Country:US
Practice Address - Phone:308-627-6119
Practice Address - Fax:308-224-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 261QM0850X, 261QM0855X
NE1219261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1219OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER
NE10026398900Medicaid
AZ21334OtherLICENSED CLINICAL SOCIAL WORKER
AZ21943OtherLICENSED PROFESSIONAL COUNSELOR