Individual
MS. ANGELA RENEE SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 S 125TH EAST AVE STE 106, TULSA, OK 74129-5800
(918) 574-8442
(918) 591-3955
Mailing address
23110 E 67TH ST S, BROKEN ARROW, OK 74014-2103
(918) 630-4663
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
311698
OK
Other
Enumeration date
06/20/2017
Last updated
02/22/2024
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