Provider Demographics
NPI:1558406793
Name:SHORT, DEBORAH LEE (MED)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEE
Last Name:SHORT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 W CHILTON AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-4749
Mailing Address - Country:US
Mailing Address - Phone:480-539-6160
Mailing Address - Fax:
Practice Address - Street 1:20435 S ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-9676
Practice Address - Country:US
Practice Address - Phone:480-987-5956
Practice Address - Fax:480-987-5947
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool