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NPI Code Detail

MEDICARE: MRS. MONIQUE SHORT

MEDICARE: MRS. MONIQUE SHORT
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
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator
3251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1417203019
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MONIQUE SHORT
Provider Business Mailing Address
First Line : 712 NW 52ND ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-6007
Country : US
Telephone Number : 405-706-4996
Fax Number :
Provider Business Practice Location Address
First Line : 2828 NW 57TH ST
Second Line : SUITE 302
City : OKLAHOMA CITY
State : OK
Zip : 73112-6814
Country : US
Telephone Number : 405-840-1234
Fax Number : 405-840-1211
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2012
Last Update Date : 08/01/2012

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Directions to “ MRS. MONIQUE SHORT ” Practice Location

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