Provider Demographics
NPI:1225835382
Name:SHOULTZ, DEANA M (PPSC)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:M
Last Name:SHOULTZ
Suffix:
Gender:
Credentials:PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W D ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3026
Mailing Address - Country:US
Mailing Address - Phone:909-459-2500
Mailing Address - Fax:
Practice Address - Street 1:950 W D ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3026
Practice Address - Country:US
Practice Address - Phone:909-459-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220276191101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool