Provider Demographics
NPI:1619275310
Name:SHORT, JAMES JOSHUA
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSHUA
Last Name:SHORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 CULLY RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8502
Mailing Address - Country:US
Mailing Address - Phone:901-283-7340
Mailing Address - Fax:901-624-2928
Practice Address - Street 1:1155 CULLY RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8502
Practice Address - Country:US
Practice Address - Phone:901-283-7340
Practice Address - Fax:901-624-2928
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor