Provider Demographics
NPI:1972622421
Name:GLENN SHORT'S APPLIED ALTERNATIVES, LLC
Entity Type:Organization
Organization Name:GLENN SHORT'S APPLIED ALTERNATIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:432-294-0732
Mailing Address - Street 1:405 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-3303
Mailing Address - Country:US
Mailing Address - Phone:432-294-0732
Mailing Address - Fax:432-837-2039
Practice Address - Street 1:405 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-3303
Practice Address - Country:US
Practice Address - Phone:432-294-0732
Practice Address - Fax:432-837-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty