Provider Demographics
NPI:1558528844
Name:SHULTZ, MARILYN (LMFT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9771 HIGHWAY 47
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:OR
Mailing Address - Zip Code:97111-9521
Mailing Address - Country:US
Mailing Address - Phone:503-550-5497
Mailing Address - Fax:503-852-6595
Practice Address - Street 1:9771 HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:CARLTON
Practice Address - State:OR
Practice Address - Zip Code:97111-9521
Practice Address - Country:US
Practice Address - Phone:503-550-5497
Practice Address - Fax:503-852-6595
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist