Provider Demographics
NPI:1528401932
Name:STULTZ, WILLIAM FREDERICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:STULTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:FRED
Other - Middle Name:
Other - Last Name:STULTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1624 BONFORTE BLVD
Mailing Address - Street 2:UNIT C
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1679
Mailing Address - Country:US
Mailing Address - Phone:719-546-1300
Mailing Address - Fax:
Practice Address - Street 1:1624 BONFORTE BLVD
Practice Address - Street 2:UNIT C
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1679
Practice Address - Country:US
Practice Address - Phone:719-546-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO539106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist