Provider Demographics
NPI:1619624889
Name:SCHULTZ, TARA LYNN (MA, LMHC, MPA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MA, LMHC, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 WEHRLE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7383
Mailing Address - Country:US
Mailing Address - Phone:716-553-2084
Mailing Address - Fax:
Practice Address - Street 1:2805 WEHRLE DR STE 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7383
Practice Address - Country:US
Practice Address - Phone:716-553-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP114407101YM0800X
NY012604-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health