Provider Demographics
NPI:1619142734
Name:SHORT, BETTYE (LPC)
Entity Type:Individual
Prefix:MS
First Name:BETTYE
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W. BEN WHITE BLVD
Mailing Address - Street 2:108A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:512-445-1033
Mailing Address - Fax:512-494-0788
Practice Address - Street 1:1221 W. BEN WHITE BLVD
Practice Address - Street 2:SUITE 108A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:512-445-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
09576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX09576OtherTEXAS STATE BOARD OF LICENSED PROFESSIONAL COUNSELORS