Provider Demographics
NPI:1881927986
Name:SCHULTZ, KRYSTAL G (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:G
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KRYSTAL
Other - Middle Name:GAYLE
Other - Last Name:WILCOX-SCHULTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:119 HOPEWELL DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5576
Mailing Address - Country:US
Mailing Address - Phone:724-272-3174
Mailing Address - Fax:
Practice Address - Street 1:3701 BURGOON RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1715
Practice Address - Country:US
Practice Address - Phone:814-944-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC50042101YM0800X, 101YP2500X
PAPC005142101YP2500X
PAPS019393103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC50042OtherPROCESSIONAL COUNSELOR
PAPS019393OtherPSYCHOLOGY