Provider Demographics
NPI:1982465282
Name:SCHULTZ, CARLY (LMSW, CFLE)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:
Credentials:LMSW, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HERON DR NW APT 302J
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-1644
Mailing Address - Country:US
Mailing Address - Phone:616-307-2328
Mailing Address - Fax:
Practice Address - Street 1:48 HERON DR NW APT 302J
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-1644
Practice Address - Country:US
Practice Address - Phone:616-307-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851115603104100000X
MI68011201891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker