Provider Demographics
NPI:1386194181
Name:DR. CARLENE SHULTZ, P.C.
Entity Type:Organization
Organization Name:DR. CARLENE SHULTZ, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-581-6032
Mailing Address - Street 1:1060 LEFFELLE ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2969
Mailing Address - Country:US
Mailing Address - Phone:503-581-6032
Mailing Address - Fax:
Practice Address - Street 1:1060 LEFFELLE ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2969
Practice Address - Country:US
Practice Address - Phone:503-581-6032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1510103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty