Provider Demographics
NPI:1689040446
Name:SHULTZ, TAYLOR (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 LYNDALE AVE S STE 440
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2380
Mailing Address - Country:US
Mailing Address - Phone:612-712-7200
Mailing Address - Fax:
Practice Address - Street 1:6625 LYNDALE AVE S STE 440
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2380
Practice Address - Country:US
Practice Address - Phone:651-373-1055
Practice Address - Fax:612-241-1943
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01517101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional