Provider Demographics
NPI:1275501306
Name:SCHULTHEISS, MARK (LMFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SCHULTHEISS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3835
Mailing Address - Country:US
Mailing Address - Phone:970-495-4604
Mailing Address - Fax:970-663-5601
Practice Address - Street 1:1501 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3835
Practice Address - Country:US
Practice Address - Phone:970-495-4604
Practice Address - Fax:970-663-5601
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO604106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist