Provider Demographics
NPI:1235410267
Name:STULTS, CHRISTOPHER B (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:STULTS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W 152ND ST APT 51
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1818
Mailing Address - Country:US
Mailing Address - Phone:917-668-0828
Mailing Address - Fax:
Practice Address - Street 1:450 W 152ND ST APT 51
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1818
Practice Address - Country:US
Practice Address - Phone:917-668-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-03
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023984103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist