NPIMap

Organization Active NPI

Monty Shultz Counseling & Neurofeedback LLC

  • Adult Mental Health Clinic/Center
  • Prescott, AZ
National Provider Identifier
1063839595
Registry record updated May 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
1219 Issued in NE
Legal business name
MONTY SHULTZ COUNSELING & NEUROFEEDBACK LLC
Practice address
141 S McCormick St Ste 100
Prescott, AZ 86303-4730
Phone
(308) 627-4743
Fax
(928) 852-0804
NPI assigned
Mar 21, 2014
Last updated
May 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Monty Shultz, LICSWNPI 1558691279
Title
President
Phone
(308) 627-6119

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU
Adult Mental Health Clinic/Center 261QM0850X 1219 NE Primary
Mental Health Counselor 101YM0800X NU

Addresses

Primary practice location

141 S McCormick St Ste 100
Prescott, AZ 86303-4730

Mailing address

141 S McCormick St Ste 100
Prescott, AZ 86303-4730
Phone (308) 627-4743

Other identifiers 2

IdentifierTypeStateIssuer
10026398900MedicaidNE
1219OtherNELICENSED INDEPENDENT CLINICAL SOCIAL WORKER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140715000264 NE Part B Supplier - Clinic/Group Practice 5991920696 Receives reassigned benefits from 1 practitioner
Practice locations: Kearney, NE

National Provider Directory

National Provider Directory

Locations

141 S McCormick St
Prescott, AZ 86303
Phone (928) 515-4967

141 S McCormick St
Ste 100
Prescott, AZ 86303
Phone (308) 627-4743

2002 Central Ave
Kearney, NE 68847
Phone (308) 627-4743

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746662400000",
    "number": "1063839595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 S MCCORMICK ST STE 100",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863034730",
            "telephone_number": "308-627-4743",
            "fax_number": "928-852-0804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 S MCCORMICK ST STE 100",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863034730",
            "telephone_number": "308-627-4743",
            "fax_number": "928-852-0804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTY SHULTZ COUNSELING & NEUROFEEDBACK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-21",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A",
        "authorized_official_last_name": "SHULTZ",
        "authorized_official_first_name": "MONTY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "308-627-6119",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NE",
            "license": "1219",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026398900",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED INDEPENDENT CLINICAL SOCIAL WORKER",
            "identifier": "1219",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.