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General NPI Number Information
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NPI Number | 1124291778
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Entity Type | Individual
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Provider Name | MARK PHILO SHORT PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2008
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 2780 S JONES BLVD STE 108
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City | LAS VEGAS
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State | NV
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Zip | 89146-5625
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Country | US
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Telephone | 702-606-3295
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Fax |
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Provider Business Mailing Address
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Address Line | 2780 S JONES BLVD STE 108
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City | LAS VEGAS
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State | NV
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Zip | 89146-5625
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Country | US
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Telephone | 702-606-3295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0780
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License Number State | NV
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