Provider Demographics
NPI:1790193795
Name:SHULTZ, LAURA SCHWENT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:SCHWENT
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:SCHWENT SHULTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:P O BOX 1000 DEPT 978
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-387-2900
Mailing Address - Fax:
Practice Address - Street 1:3950 NEW COVINGTON PIKE STE 110
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2595
Practice Address - Country:US
Practice Address - Phone:901-387-2900
Practice Address - Fax:901-384-1645
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3126103TC0700X, 103TC0700X
103T00000X, 103TA0700X, 103TB0200X, 103TP2701X, 103TH0004X, 103TH0100X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008612Medicaid
TN6191083OtherBCBS MEDICAL
TN6187679OtherBCBS BEHAVIORAL HEALTH