Provider Demographics
NPI:1871546002
Name:STULTZ, MARIKAY (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARIKAY
Middle Name:
Last Name:STULTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 WAYNETOWN RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1160
Mailing Address - Country:US
Mailing Address - Phone:765-361-0503
Mailing Address - Fax:
Practice Address - Street 1:701 N. ENGLEWOOD DR.
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-9744
Practice Address - Country:US
Practice Address - Phone:765-361-9767
Practice Address - Fax:765-361-0374
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000086A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000194497OtherANTHEM BCBS PROVIDER PIN
IN000000194497OtherANTHEM BCBS PROVIDER PIN