Provider Demographics
NPI:1790422079
Name:SHORT, KORRINA MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:KORRINA
Middle Name:MARIE
Last Name:SHORT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 PADDOCK LANDING ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1037
Mailing Address - Country:US
Mailing Address - Phone:713-530-9285
Mailing Address - Fax:
Practice Address - Street 1:903 GREATWOOD GLEN DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6178
Practice Address - Country:US
Practice Address - Phone:281-223-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst