Provider Demographics
NPI:1447566153
Name:SCHULTZ, LORA KATHLEEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:KATHLEEN
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-0090
Mailing Address - Country:US
Mailing Address - Phone:707-465-5009
Mailing Address - Fax:707-465-5009
Practice Address - Street 1:508 H ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3722
Practice Address - Country:US
Practice Address - Phone:707-465-5009
Practice Address - Fax:707-465-5009
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA195591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical