Provider Demographics
NPI:1336906270
Name:SCHULTZ, SASHA ANTOINELLE (AMFT #145454)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:ANTOINELLE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:AMFT #145454
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927 E 93RD PL APT 1904
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3666
Mailing Address - Country:US
Mailing Address - Phone:917-364-4212
Mailing Address - Fax:
Practice Address - Street 1:700 W E ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5984
Practice Address - Country:US
Practice Address - Phone:858-751-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist