MEDICARE: DR. SHOSHANNA 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
1	101YP2500X	Professional Counselor	0012079	CO
2	101YM0800X	Mental Health Counselor	0012079	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1700288065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHOSHANNA SHACHTMAN ED.D, LPC, NCC

Provider Business Mailing Address
First Line	:	760 WHALERS WAY STE 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3370
Country	:	US
Telephone Number	:	720-380-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 WHALERS WAY STE 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3370
Country	:	US
Telephone Number	:	720-380-3725
Fax Number	:

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

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	06/10/2024

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