Organization
BREVARD PSYCHOLOGICAL ASSOCIATES, INC
Active
Other names
Timothy C. Short, Psy. D
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY C SHORT, PSY. D PSYCHOLOGIST (OWNER)
(321) 724-2444
Entity
Organization
Contact information
Practice address
1611 S APOLLO BLVD, MELBOURNE, FL 32901-4407
(321) 724-2444
(321) 952-4131
Mailing address
1611 SOUTH APOLLO BLVD., MELBOURNE, FL 32901
(321) 724-2444
(321) 952-4131
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
PY4790
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59348
BLUE CROSS BLUE SHIELT OF FLORIDA
FL
01
—
611051700
WORKERS COMPENSATION
FL
Enumeration date
03/25/2015
Last updated
03/25/2015
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