Provider Demographics
NPI:1912694555
Name:SHORT, HANNAH G (LPC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:G
Last Name:SHORT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:G
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5486 S DOLLISON PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2920
Mailing Address - Country:US
Mailing Address - Phone:417-496-4055
Mailing Address - Fax:
Practice Address - Street 1:3322 S CAMPBELL AVE STE R
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4980
Practice Address - Country:US
Practice Address - Phone:417-509-9572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022045283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional