Provider Demographics
NPI:1548531452
Name:SHORT, DONALD D (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:D
Last Name:SHORT
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 LORMAND RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-4420
Mailing Address - Country:US
Mailing Address - Phone:337-230-0533
Mailing Address - Fax:337-856-8127
Practice Address - Street 1:110 TRAVIS ST
Practice Address - Street 2:STE 204
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2452
Practice Address - Country:US
Practice Address - Phone:337-230-0533
Practice Address - Fax:337-856-8127
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2669101YP2500X
LA648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist