Provider Demographics
NPI:1841330214
Name:STUTZ, SCOTT MICHAEL (MFT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:STUTZ
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 MELODY LN STE 105
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5100
Mailing Address - Country:US
Mailing Address - Phone:916-532-6397
Mailing Address - Fax:
Practice Address - Street 1:1198 MELODY LN STE 105
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5100
Practice Address - Country:US
Practice Address - Phone:916-532-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XMedicaid