Provider Demographics
NPI:1780034975
Name:SCHULTZE, EDWARD WARREN JR (MFT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:WARREN
Last Name:SCHULTZE
Suffix:JR
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E MINARETS AVE
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93650-1239
Mailing Address - Country:US
Mailing Address - Phone:855-343-1057
Mailing Address - Fax:844-587-6405
Practice Address - Street 1:40 E MINARETS AVE
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:CA
Practice Address - Zip Code:93650-1239
Practice Address - Country:US
Practice Address - Phone:855-343-1057
Practice Address - Fax:844-587-6405
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF89178106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013030808Medicaid