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NPI Code Detail

MEDICARE: GLENN SHORT LPC

MEDICARE: GLENN SHORT LPC
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
1101YP2500XProfessional Counselor20028TX

General Provider Information

NPI Number : 1497212195
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENN SHORT LPC
Provider Business Mailing Address
First Line : 700 N MAIN ST
Second Line :
City : FORT STOCKTON
State : TX
Zip : 79735-5626
Country : US
Telephone Number : 432-336-8110
Fax Number :
Provider Business Practice Location Address
First Line : 700 N MAIN ST
Second Line :
City : FORT STOCKTON
State : TX
Zip : 79735-5626
Country : US
Telephone Number : 432-336-8110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2019
Last Update Date : 02/28/2019

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Directions to “ GLENN SHORT LPC” Practice Location

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