Individual
MS. COLLEEN ACADIA SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT, LMHC
Contact information
Practice address
814 GILMER RD STE 1, LONGVIEW, TX 75604-3614
(903) 692-3724
Mailing address
924 COUNTY ROAD 337, DE BERRY, TX 75639-2454
(903) 692-3724
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LH61185743
WA
106H00000X
Marriage & Family Therapist
Primary
204896
TX
106H00000X
Marriage & Family Therapist
LF61280351
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15394067
CAQH
—
Enumeration date
01/21/2014
Last updated
01/13/2024
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