MEDICARE: BRIAN SHILTS MS, LMHC, CSAYC

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	101YM0800X	Mental Health Counselor	88000476A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER	IN	NONE

General Provider Information

NPI Number	:	1962157131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN SHILTS MS, LMHC, CSAYC

Provider Business Mailing Address
First Line	:	2632 SPRINGFIELD AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-1550
Country	:	US
Telephone Number	:	260-341-2651
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 SPRINGFIELD AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-1550
Country	:	US
Telephone Number	:	260-341-2651
Fax Number	:

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

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	03/23/2026

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