1386649622 NPI number — MR. GARY MICHAEL SCHULTHEIS LCSW, LMFT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386649622 NPI number — MR. GARY MICHAEL SCHULTHEIS LCSW, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULTHEIS
Provider First Name:
GARY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386649622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 BELLEMEADE AVE
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47714-0102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-477-2350
Provider Business Mailing Address Fax Number:
812-477-2378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 BELLEMEADE AVE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47714-0102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-477-2350
Provider Business Practice Location Address Fax Number:
812-477-2378
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34002273A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 35000058A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 241976000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000234060 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7014115 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 262775 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 67230 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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