Healthcare Provider Details

I. General information

NPI: 1114940319
Provider Name (Legal Business Name): DANIEL NEWTON SHORT PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9855 E LARKSPUR DR
SCOTTSDALE AZ
85260-5145
US

IV. Provider business mailing address

9855 E LARKSPUR DR
SCOTTSDALE AZ
85260-5145
US

V. Phone/Fax

Practice location:
  • Phone: 480-329-5359
  • Fax: 602-718-5110
Mailing address:
  • Phone: 480-392-5359
  • Fax: 602-718-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3499
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: