Provider Demographics
NPI:1679316442
Name:SCHULTZ, TAYLOR
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 SKY MOUNTAIN DR APT 136
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-6133
Mailing Address - Country:US
Mailing Address - Phone:920-286-0353
Mailing Address - Fax:
Practice Address - Street 1:2440 VASSAR ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3453
Practice Address - Country:US
Practice Address - Phone:775-448-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT4327106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT4327OtherSTATE OF NEVADA BOARD OF APPLIED BEHAVIOR ANALYSIS
RBT-24-353930OtherBEHAVIOR ANALYST CERTIFICATION BOARD