Provider Demographics
NPI:1194894048
Name:WARREN, JEANNIE LYNN
Entity type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:LYNN
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 PINE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1835
Mailing Address - Country:US
Mailing Address - Phone:618-444-8761
Mailing Address - Fax:
Practice Address - Street 1:3218 PINE FOREST DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1835
Practice Address - Country:US
Practice Address - Phone:618-444-8761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor