Provider Demographics
NPI:1093316903
Name:SHORTES, CHRISTI
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:
Last Name:SHORTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S FILES ST
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:TX
Mailing Address - Zip Code:76055-3001
Mailing Address - Country:US
Mailing Address - Phone:354-707-0058
Mailing Address - Fax:
Practice Address - Street 1:5024 FM 304
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75109
Practice Address - Country:US
Practice Address - Phone:469-285-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional