Provider Demographics
NPI:1649419359
Name:SCHULTZ, MARY KAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY KAY
Other - Middle Name:
Other - Last Name:HOUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:88 THUNDER RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622-6406
Mailing Address - Country:US
Mailing Address - Phone:609-510-4007
Mailing Address - Fax:
Practice Address - Street 1:821 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2102
Practice Address - Country:US
Practice Address - Phone:660-826-4774
Practice Address - Fax:660-826-1300
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL054820001041C0700X
MO20140299331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical