Provider Demographics
NPI:1619004462
Name:SCHULTZ, ROSA MARIE (CBHCM, LPC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:CBHCM, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NW G ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-1757
Mailing Address - Country:US
Mailing Address - Phone:918-967-9221
Mailing Address - Fax:
Practice Address - Street 1:400 E WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5464
Practice Address - Country:US
Practice Address - Phone:918-420-5238
Practice Address - Fax:918-420-5717
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional