Amy Shull LPC LMFT
Organization Active NPI Community/Behavioral Health Agency · Fort Collins, CO
NPI 1164033023 · NPPES record last updated Aug 13, 2020
Key facts
- NPI
- 1164033023
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- AMY SHULL LPC LMFT
- Practice address
- 300 E Horsetooth Rd Ste 200
Fort Collins, CO 80525-3154 - Phone
- (650) 504-0539
- NPI assigned
- Aug 13, 2020
- Organization subpart
- No
Authorized official
- Name
- Amy Shull
- Title
- Owner
- Phone
- (650) 504-0539
Practitioners 1
-
Amy Lynne Shull, MFT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250102002914 | CO | Part B Supplier - Clinic/Group Practice | 2668909623 |
Receives reassigned benefits from 1 practitioner Practice locations: Fort Collins, CO |
National Provider Directory
Locations
300 E Horsetooth Rd
Ste 200
Fort Collins, CO 80525
Phone (405) 474-4833
1006 Robertson St
Ste 110
Fort Collins, CO 80524
Phone (650) 504-0539
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
300 E Horsetooth Rd Ste 200
Fort Collins, CO 80525-3154
Mailing address
300 E Horsetooth Rd Ste 200
Fort Collins, CO 80525-3154
Phone (650) 504-0539
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.