Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ASW66482 | CA |
Y | 101YM0800X | Mental Health Counselor | LCSW97941 | CA |
NPI | 1003263401 |
---|---|
Provider Name | Pamela Short |
First Address | Mariposa, CA 95338-9556 |
Second Address | Merced, CA 95341-6211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2016 |
Last Update Date | 02/12/2020 |