Provider Demographics
NPI:1659443216
Name:SCHULTZ, JANICE HAUSER (PSYD, LPC)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:HAUSER
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3345
Mailing Address - Country:US
Mailing Address - Phone:719-250-5888
Mailing Address - Fax:855-775-0361
Practice Address - Street 1:720 N MAIN ST STE 240
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3046
Practice Address - Country:US
Practice Address - Phone:719-250-5888
Practice Address - Fax:855-775-0361
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CO1421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149674Medicaid
CO068103Medicaid