Provider Demographics
NPI:1871788653
Name:ENEBO-SHORT, DEANA M (LMHC)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:M
Last Name:ENEBO-SHORT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:M
Other - Last Name:ENEBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-0657
Mailing Address - Country:US
Mailing Address - Phone:360-990-5305
Mailing Address - Fax:
Practice Address - Street 1:5610 KITSAP WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2292
Practice Address - Country:US
Practice Address - Phone:360-990-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health