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

Q: 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.

Q: What is Shane Church's specialty?

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

Q: 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 12 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.

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: August 09, 2026.

On this page

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 and is a graduate of Other (2018).

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

Medical School CMSOtherGraduated 2018

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), UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

PECOS PAC ID8123520335

PECOS Enrollment IDI20250906000935

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.

Other Providers at the Same Location NPPES 14

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

JAMILA MILLETTE LMHC

Counselor (Mental Health)