Provider Demographics
NPI:1073638755
Name:SHULER, JOHN GARY (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GARY
Last Name:SHULER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N EAST AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5226
Mailing Address - Country:US
Mailing Address - Phone:479-871-8751
Mailing Address - Fax:
Practice Address - Street 1:221 N EAST AVE
Practice Address - Street 2:206
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5226
Practice Address - Country:US
Practice Address - Phone:479-871-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1570-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical