Provider Demographics
NPI:1518374511
Name:SCHMALTZ, KATHLEEN (LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SCHMALTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3144
Mailing Address - Country:US
Mailing Address - Phone:701-663-2122
Mailing Address - Fax:701-663-7521
Practice Address - Street 1:314 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3144
Practice Address - Country:US
Practice Address - Phone:701-663-2122
Practice Address - Fax:701-663-7521
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND607-7-1-08101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional