Provider Demographics
NPI:1922694868
Name:SHORT, BROOKE MORGAN
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MORGAN
Last Name:SHORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 S GUM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-8375
Mailing Address - Country:US
Mailing Address - Phone:812-592-5186
Mailing Address - Fax:
Practice Address - Street 1:643 S GUM ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-8375
Practice Address - Country:US
Practice Address - Phone:812-592-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)