Provider Demographics
NPI:1306610886
Name:SHORT, BETH ANN (MA, ATR-BC, ATCS)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:SHORT
Suffix:
Gender:F
Credentials:MA, ATR-BC, ATCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 SE 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4718
Mailing Address - Country:US
Mailing Address - Phone:503-341-7280
Mailing Address - Fax:
Practice Address - Street 1:4705 SE 60TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-4718
Practice Address - Country:US
Practice Address - Phone:503-341-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORART-C-10205598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health