Provider Demographics
NPI:1386649622
Name:SCHULTHEIS, GARY MICHAEL (LCSW, LMFT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:SCHULTHEIS
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 BELLEMEADE AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0102
Mailing Address - Country:US
Mailing Address - Phone:812-477-2350
Mailing Address - Fax:812-477-2378
Practice Address - Street 1:3700 BELLEMEADE AVE
Practice Address - Street 2:STE 110
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0102
Practice Address - Country:US
Practice Address - Phone:812-477-2350
Practice Address - Fax:812-477-2378
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002273A1041C0700X
IN35000058A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
241976000OtherMAGELLAN
000000234060OtherBLUE CROSS/BLUE SHIELD
7014115OtherAETNA
262775OtherVALUE OPTIONS
67230OtherCIGNA