Provider Demographics
NPI:1871862177
Name:SCHULTZ, KELLY KRUPA (LLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KRUPA
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4448 OAKBRIDGE DR STE C
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5484
Mailing Address - Country:US
Mailing Address - Phone:810-342-5333
Mailing Address - Fax:810-342-5335
Practice Address - Street 1:4448 OAKBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5484
Practice Address - Country:US
Practice Address - Phone:810-342-5337
Practice Address - Fax:810-342-5335
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361005666103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist