Provider Demographics
NPI:1366203887
Name:SHORT, MATTHEW J (MS, LPC-ASSOCIATE)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:SHORT
Suffix:
Gender:M
Credentials:MS, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 57TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5607
Mailing Address - Country:US
Mailing Address - Phone:806-787-0090
Mailing Address - Fax:
Practice Address - Street 1:4601 50TH ST STE 209
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3515
Practice Address - Country:US
Practice Address - Phone:806-787-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional