Provider Demographics
NPI:1992845689
Name:SCHULTZ, OTTO B (LADC)
Entity Type:Individual
Prefix:
First Name:OTTO
Middle Name:B
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1351
Mailing Address - Country:US
Mailing Address - Phone:402-421-3462
Mailing Address - Fax:402-421-3462
Practice Address - Street 1:4626 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1351
Practice Address - Country:US
Practice Address - Phone:402-421-3462
Practice Address - Fax:402-421-3462
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE211101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)