Provider Demographics
NPI:1427134394
Name:WARREN, SUSAN (MA, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 N CAMINO LIBBY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2028
Mailing Address - Country:US
Mailing Address - Phone:520-742-1780
Mailing Address - Fax:520-575-7183
Practice Address - Street 1:6510 N CAMINO LIBBY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-2028
Practice Address - Country:US
Practice Address - Phone:520-742-1780
Practice Address - Fax:520-575-7183
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 1182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health