Provider Demographics
NPI:1114281185
Name:SHULTZ, MISTY MICHELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:MICHELLE
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-2103
Mailing Address - Country:US
Mailing Address - Phone:817-526-4401
Mailing Address - Fax:
Practice Address - Street 1:1215 HONEYSUCKLE DR
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059-2103
Practice Address - Country:US
Practice Address - Phone:817-526-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional