Shane Church, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH24135 Issued in FL

Practice address

4776 New Broad St Ste 201
Orlando, FL 32814-6423

Phone

(833) 769-3524

Fax

(407) 219-9624

NPI assigned

Mar 6, 2017

Sex

Male

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

Enrolled in FL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Personal Recovery Network LLC

  • Psychiatry Physician
  • Stockbridge, GA
  • NPI 1881990869

  FL

  Medicare reassignment NPD

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

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1194265405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4776 NEW BROAD ST STE 201",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328146423",
            "telephone_number": "833-769-3524",
            "fax_number": "407-219-9624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4776 NEW BROAD ST STE 201",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328146423",
            "telephone_number": "833-769-3524",
            "fax_number": "407-219-9624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "SHANE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-06",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH24135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Chung, M.D.
• Sook Ok Chung, AP, LAC, NCCAOM, DOM
• Valerie Chung
• Elizabeth Ann Chupp
• Annamaria T Church, MD
• Steven Churchill, DPT
• Joseph Chuy, DDS
• Susanna Chyu, DO
• Remigio Gabriel Ciampi
• Verna Siddayao Ciaponi, RN

• Mental Health Counselor in Orlando, FL
• Providers in Orlando, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.