Provider Demographics
NPI:1093402901
Name:MATHEWS-SHORTS, ANGELA RENEE (PSYD ABD LMFT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:MATHEWS-SHORTS
Suffix:
Gender:F
Credentials:PSYD ABD LMFT
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:MATHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:18470 CACTUS AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-8738
Mailing Address - Country:US
Mailing Address - Phone:714-392-1814
Mailing Address - Fax:
Practice Address - Street 1:18470 CACTUS AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-8738
Practice Address - Country:US
Practice Address - Phone:714-392-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123340106H00000X
CA124430106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist