Individual
MS. MARIKAY STULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
701 N. ENGLEWOOD DR., CRAWFORDSVILLE, IN 47933-9744
(765) 361-9767
(765) 361-0374
Mailing address
510 WAYNETOWN RD, CRAWFORDSVILLE, IN 47933-1160
(765) 361-0503
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34000086A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000194497
ANTHEM BCBS PROVIDER PIN
IN
Enumeration date
05/18/2006
Last updated
11/07/2008
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