Provider Demographics
NPI:1164109567
Name:SHULTS, GARRETT RICHARD (MA (INTERNSHIP))
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:RICHARD
Last Name:SHULTS
Suffix:
Gender:M
Credentials:MA (INTERNSHIP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01506-1862
Mailing Address - Country:US
Mailing Address - Phone:209-485-8210
Mailing Address - Fax:
Practice Address - Street 1:411 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3339
Practice Address - Country:US
Practice Address - Phone:508-799-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor