Provider Demographics
NPI:1356347710
Name:SCHULTZ, DANIEL L (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N FRANKLIN ST. SUITE 230
Mailing Address - Street 2:CLINICAL PSYCHOLOGY CENTER PC
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-462-4770
Mailing Address - Fax:219-464-8156
Practice Address - Street 1:15 N FRANKLIN ST.
Practice Address - Street 2:CLINICAL PSYCHOLOGY CENTER PC
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-462-4770
Practice Address - Fax:219-464-8156
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-07-06
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
IN20010329A103TC0700X
IN20010329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100208230AMedicaid
IN100208230AMedicaid
INR33669Medicare UPIN