Provider Demographics
NPI:1972892180
Name:SCHULTZ, MICHELLE SUZANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 WOODMAN DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-1446
Mailing Address - Country:US
Mailing Address - Phone:937-254-9210
Mailing Address - Fax:937-254-9267
Practice Address - Street 1:9 N EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-8470
Practice Address - Country:US
Practice Address - Phone:937-775-4333
Practice Address - Fax:937-775-4323
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6633103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist