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SHANE CHURCH LMHC
NPI 1194265405
Counselor - Mental Health in Orlando, FL

Active since March 06, 2017PECOS Enrolled
4776 NEW BROAD ST STE 201, ORLANDO, FL 32814(833) 769-3524(407) 219-9624 Get Directions Write a Review

NPPES record last updated: August 6, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Shane Church Lmhc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANE CHURCH LMHC (NPI 1194265405) is an individual mental health provider in Orlando, Florida, licensed in Florida (MH24135) and active in the NPI registry since March 2017. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1194265405
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameSHANE CHURCHCredential: LMHC
Location Address4776 NEW BROAD ST STE 201Orlando, FL 32814-6423
Mailing Address4776 New Broad St Ste 201Orlando, FL 32814-6423 · (833) 769-3524 · Fax (407) 219-9624
Phone(833) 769-3524
Fax(407) 219-9624
Sole ProprietorNo
Enumeration DateMarch 6, 2017
Last NPPES UpdateAugust 6, 2025
NPPES CertifiedAugust 6, 2025
✔ NPI 1194265405 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in FL · MH24135
4776 NEW BROAD ST STE 201, Orlando, FL 32814
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shane Church Lmhc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Shane Church reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Personal Recovery Network LLC
381 mi
Psychiatry
250 CORPORATE CENTER CT
Stockbridge, GA 30281
  • Reassigned Medicare billing, Florida enrollment
  • 408 clinicians in this Medicare group
NPI 1881990869 (770) 389-8100

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAMILA MILLETTE LMHC
Counselor (Mental Health)
4776 NEW BROAD ST STE 201
ORLANDO, FL 32814
Orange County (877) 653-5907
XAVIER BERRIOS APONTE PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
4776 NEW BROAD ST STE 201
ORLANDO, FL 32814
Orange County (833) 769-3524
MS. DEBRA LYNNE FRANZEN NP
Nurse Practitioner (Psychiatric/Mental Health)
4776 NEW BROAD ST STE 201
ORLANDO, FL 32814
Orange County (407) 871-9490
DULCE MARIA MERIDA LMHC, MS
Counselor (Mental Health)
4776 NEW BROAD ST STE 201
ORLANDO, FL 32814
Orange County (833) 769-3524
JULIE WYNN RCSWI
Social Worker (Clinical)
4776 NEW BROAD ST STE 201
ORLANDO, FL 32814
Orange County (407) 871-9490
MRS. TOBY A LUCAS LCSW
Social Worker (Clinical)
4776 NEW BROAD ST STE 201
ORLANDO, FL 32814
Orange County (833) 769-3524
MISS CAMILLE BOCKER PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
4776 NEW BROAD ST STE 201
ORLANDO, FL 32814
Orange County (407) 871-9490
KIMBERLY ALDEN LMHC
Counselor (Mental Health)
4776 NEW BROAD ST STE 201
ORLANDO, FL 32814
Orange County (833) 769-3524

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shane Church's NPI number?

The NPI number for Shane Church is 1194265405. It was assigned to this individual provider in the NPPES registry on March 6, 2017.

Where is Shane Church located?

Shane Church practices at 4776 New Broad St Ste 201, Orlando, FL 32814. The listed phone number is (833) 769-3524.

What is Shane Church's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Shane Church enrolled in Medicare?

Yes. Shane Church is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Shane Church's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shane Church reassigns Medicare benefits to Personal Recovery Network LLC (Stockbridge, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shane Church's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Shane Church accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Shane Church as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shane Church was last updated on August 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.