Individual
TIMOTHY C SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1611 S APOLLO BLVD, MELBOURNE, FL 32901-4407
(321) 724-2444
(321) 952-4131
Mailing address
1611 S APOLLO BLVD, MELBOURNE, FL 32901-4407
(321) 724-2444
(321) 952-4131
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
PY4790
FL
Other
Enumeration date
08/14/2006
Last updated
09/09/2008
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