Provider Demographics
NPI:1891022729
Name:STULTZ, JEAN ELIZABETH (PHD,LMFT)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:ELIZABETH
Last Name:STULTZ
Suffix:
Gender:F
Credentials:PHD,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1744
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1744
Mailing Address - Country:US
Mailing Address - Phone:805-698-5802
Mailing Address - Fax:805-698-5802
Practice Address - Street 1:2024 CASTILLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4204
Practice Address - Country:US
Practice Address - Phone:805-698-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA95091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000009153OtherUPIN