Individual
MR. KELLY J SCHULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.C,S.A.C.
Contact information
Practice address
540 COLLEGE AVE, MEDFORD, WI 54451-2027
(715) 748-3332
(715) 748-3342
Mailing address
540 COLLEGE AVE, MEDFORD, WI 54451-2027
(715) 748-3332
(715) 748-3342
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
13934-131
WI
101YM0800X
Mental Health Counselor
Primary
13934-131
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13934-131
STATE LIC NUMBER
WI
05
—
43576100
—
WI
Enumeration date
05/11/2007
Last updated
12/23/2015
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