Provider Demographics
NPI:1821184110
Name:CLINICAL PSYCHOLOGY CENTER, P.C.
Entity type:Organization
Organization Name:CLINICAL PSYCHOLOGY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-462-4770
Mailing Address - Street 1:15 N FRANKLIN ST
Mailing Address - Street 2:SUITE 230
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:SUITE 230
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010329A103TC0700X
IN103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200023980Medicaid
IN200023980Medicaid