Provider Demographics
NPI:1093352635
Name:SCHULZ, MARY CORINNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CORINNE
Last Name:SCHULZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 POLO DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-9745
Mailing Address - Country:US
Mailing Address - Phone:316-518-4124
Mailing Address - Fax:
Practice Address - Street 1:2907 E JOYCE BLVD STE 16
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5011
Practice Address - Country:US
Practice Address - Phone:501-263-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7505-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty