Provider Demographics
NPI:1497881767
Name:SCHULTZ, LISA A (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 SAND DUNE RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-8093
Mailing Address - Country:US
Mailing Address - Phone:505-850-2712
Mailing Address - Fax:
Practice Address - Street 1:4101 MONTREAL LOOP NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-8455
Practice Address - Country:US
Practice Address - Phone:505-867-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-22251041S0200X
NMC-077961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool