Provider Demographics
NPI:1841011442
Name:SCHULTZ, BRENT LEE (LMHC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:LEE
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 RISING SUN DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8883
Mailing Address - Country:US
Mailing Address - Phone:407-618-6795
Mailing Address - Fax:
Practice Address - Street 1:6130 RISING SUN DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8883
Practice Address - Country:US
Practice Address - Phone:407-618-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11876101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health