Provider Demographics
NPI:1447668298
Name:SCHULTZ, SARA HART (MS, LPCC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:HART
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:HART
Other - Last Name:BRODEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPCC
Mailing Address - Street 1:275 3RD ST S STE 101B
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4987
Mailing Address - Country:US
Mailing Address - Phone:651-300-4311
Mailing Address - Fax:651-309-4930
Practice Address - Street 1:275 3RD ST S STE 101B
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4987
Practice Address - Country:US
Practice Address - Phone:651-300-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional