Individual
MICHAEL CARL SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW,LCSW
Contact information
Practice address
741 N GRAND AVE, WAUKESHA, WI 53186-4820
(262) 542-3255
Mailing address
741 N GRAND AVE, WAUKESHA, WI 53186-4820
(262) 542-3255
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1698-123
WI
Other
Enumeration date
09/02/2006
Last updated
07/08/2007
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