Katie Ann Shull, LCMHA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

88002538A Issued in IN

Practice address

4630 W Jefferson Blvd Ste 3
Fort Wayne, IN 46804-6800

Phone

(260) 632-2131

NPI assigned

Aug 28, 2024

Last updated

Aug 28, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1724803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1073347407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5709 N STATE ROAD 101",
            "city": "WOODBURN",
            "state": "IN",
            "postal_code": "467979655",
            "telephone_number": "260-257-0016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4630 W JEFFERSON BLVD STE 3",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046800",
            "telephone_number": "260-632-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULL",
        "first_name": "KATIE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "LCMHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "88002538A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert M Shugart, M.D.
• Robert McDowell Shugart II
• Ellen Shuherk
• Abhijit Shukla, M.D.
• Allison Lucy Shuler, MOTR/L
• Laura A Shull
• Pamela Shull
• Clifford James Shultz, MD
• Elizabeth Jo Shultz, PHARMD
• Zachary Shultz

• Mental Health Counselor in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.