Provider Demographics
NPI:1558086967
Name:SSHORT COUNSELING LLC
Entity Type:Organization
Organization Name:SSHORT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW, LISC
Authorized Official - Phone:612-505-2694
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:JEMEZ SPRINGS
Mailing Address - State:NM
Mailing Address - Zip Code:87025-0573
Mailing Address - Country:US
Mailing Address - Phone:612-505-2694
Mailing Address - Fax:
Practice Address - Street 1:17482 HIGHWAY 4
Practice Address - Street 2:
Practice Address - City:JEMEZ SPRINGS
Practice Address - State:NM
Practice Address - Zip Code:87025
Practice Address - Country:US
Practice Address - Phone:612-505-2694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty