Provider Demographics
NPI:1366910572
Name:SCHULZE, EVAN TI (PHD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:TI
Last Name:SCHULZE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1027
Mailing Address - Country:US
Mailing Address - Phone:314-977-4807
Mailing Address - Fax:
Practice Address - Street 1:145 E 32ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6055
Practice Address - Country:US
Practice Address - Phone:212-263-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009843103G00000X, 103TC0700X
MO2018033374103G00000X, 103TC0700X
NY024949103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical