Individual
GERALD SHORTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
851 ANDREA DR STE 4, FARMINGTON, NM 87401-6726
(505) 269-5121
Mailing address
851 ANDREA DR. SUITE 4 BUILDING E, FARMINGTON, NM 87401
(505) 269-5121
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0112581
NM
Other
Enumeration date
03/11/2011
Last updated
03/11/2011
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