Provider Demographics
NPI:1801508122
Name:SHORTER, KANDRA D (LMFT)
Entity type:Individual
Prefix:
First Name:KANDRA
Middle Name:D
Last Name:SHORTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KANDRA
Other - Middle Name:D
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2332 BEVERLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-1756
Mailing Address - Country:US
Mailing Address - Phone:817-625-4254
Mailing Address - Fax:817-378-0861
Practice Address - Street 1:2909 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-4642
Practice Address - Country:US
Practice Address - Phone:817-625-4254
Practice Address - Fax:817-378-0861
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203858106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist