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NPI Code Detail

MEDICARE: SHOSHANNA K. SHACHTMAN, ED.D, LPC, NCC

MEDICARE: SHOSHANNA K. SHACHTMAN, ED.D, LPC, NCC
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
1101YP2500XProfessional Counselor0012079CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164873519
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHOSHANNA K. SHACHTMAN, ED.D, LPC, NCC
Provider Business Mailing Address
First Line : 109 CORONADO CT
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-4929
Country : US
Telephone Number : 720-380-3725
Fax Number :
Provider Business Practice Location Address
First Line : 109 CORONADO CT
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-4929
Country : US
Telephone Number : 720-380-3725
Fax Number :
Authorized Official
Title or Position : LICENSED PROFESSIONAL COUNSELOR
Name : DR. SHOSNANNA KOZBERG SHACHTMAN
Credential : ED.D, LPC, NCC
Telephone Number : 720-380-3725
Provider Enumeration Date : 06/27/2016
Last Update Date : 06/27/2016

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