Provider Demographics
NPI:1922818509
Name:SCHULTZ, JOHANNA (MA, LPCC)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 58TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-3646
Mailing Address - Country:US
Mailing Address - Phone:218-849-2613
Mailing Address - Fax:
Practice Address - Street 1:611 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4574
Practice Address - Country:US
Practice Address - Phone:612-712-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health