Individual
MALLORY SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
3320 PARK DR, STURGEON BAY, WI 54235-2325
(920) 255-8068
Mailing address
624 N 3RD AVE, STURGEON BAY, WI 54235-2325
(920) 255-8068
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5858-125
WI
101YP2500X
Professional Counselor
5858-125
WI
Other
Enumeration date
04/10/2019
Last updated
03/23/2023
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