Provider Demographics
NPI:1710609102
Name:STULTZ, SHARON KAY (MA, MED, LMHCA, EDSP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:STULTZ
Suffix:
Gender:F
Credentials:MA, MED, LMHCA, EDSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22722 29TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4401
Mailing Address - Country:US
Mailing Address - Phone:425-215-9382
Mailing Address - Fax:
Practice Address - Street 1:22722 29TH DR SE STE 153
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4401
Practice Address - Country:US
Practice Address - Phone:425-215-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WA522320A2080P0008X
WA61477333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities