Individual
MRS. JAMIE L SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., BCBA
Contact information
Practice address
1560 LAUREL LEDGE DR, LA VERGNE, TN 37086-4185
(901) 870-7053
Mailing address
1560 LAUREL LEDGE DR, LA VERGNE, TN 37086-4185
(901) 870-7053
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1517394
—
TN
Enumeration date
04/14/2008
Last updated
05/05/2016
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