MEDICARE: SHELLY ANNAMEIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT.0001945	CO

General Provider Information

NPI Number	:	1558911669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY ANNAMEIER

Provider Business Mailing Address
First Line	:	117 E MOUNTAIN AVE STE 215
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2863
Country	:	US
Telephone Number	:	970-514-8202
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 E MOUNTAIN AVE STE 215
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2863
Country	:	US
Telephone Number	:	970-514-8202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	03/16/2022

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Directions to “ SHELLY ANNAMEIER ” Practice Location

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