Individual provider Active NPI

Amy Lynne Shull, MFT

  • Marriage & Family Therapist
  • Fort Collins, CO
National Provider Identifier
1124244751
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
1500 Issued in CO
Practice address
1006 Robertson St Ste 110
Fort Collins, CO 80524-3948
Phone
(650) 504-0539
NPI assigned
Apr 18, 2007
Last updated
Aug 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 14371 CO
Marriage & Family Therapist 106H00000X 1500 CO Primary

Addresses

Primary practice location

1006 Robertson St Ste 110
Fort Collins, CO 80524-3948

Mailing address

2003 Ballyneal Dr
Fort Collins, CO 80524-2862
Phone (650) 504-0539

Other identifiers 1

IdentifierTypeStateIssuer
62984853MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250102002980 CO Practitioner - Marriage and Family Therapist 3577090539 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1006 Robertson St
Suite 110
Fort Collins, CO 80524-3948
Phone (650) 504-0539

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1500COMDAcupuncturist
14371COMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Amy Shull LPC LMFT CurrentSince Nov 16, 2024 Accepting new patients

Locations

1006 Robertson St
Ste 110
Fort Collins, CO 80524
Phone (650) 504-0539

300 E Horsetooth Rd
Ste 200
Fort Collins, CO 80525
Phone (405) 474-4833

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1124244751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 BALLYNEAL DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805242862",
            "telephone_number": "650-504-0539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 ROBERTSON ST STE 110",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243948",
            "telephone_number": "650-504-0539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULL",
        "first_name": "AMY",
        "middle_name": "LYNNE",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "14371",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CO",
            "license": "1500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "62984853",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.