=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528921418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER C. SHORTS LICENSED CLINICAL SOCIAL WORKER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2025
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 69550 HIGHWAY 111 STE 202&203
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-902-4961
-----------------------------------------------------
Fax | 760-507-8405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69550 HIGHWAY 111 STE 202&203
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-902-4961
-----------------------------------------------------
Fax | 760-507-8405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PETER CHARLES SHORTS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 760-902-4961
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------