Provider Demographics
NPI:1700544335
Name:SHULTZ, TERRY LEE (MED)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:MED
Other - Prefix:MR
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:SHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:413 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1536
Mailing Address - Country:US
Mailing Address - Phone:814-441-4508
Mailing Address - Fax:814-308-8126
Practice Address - Street 1:2023 CATO AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2765
Practice Address - Country:US
Practice Address - Phone:814-308-8375
Practice Address - Fax:814-308-8126
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013978101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional