Provider Demographics
NPI:1982285789
Name:WARREN, SHIRLEY F (AMFT)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:F
Last Name:WARREN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16175 TOKAY ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8623
Mailing Address - Country:US
Mailing Address - Phone:209-679-8801
Mailing Address - Fax:
Practice Address - Street 1:16175 TOKAY ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8623
Practice Address - Country:US
Practice Address - Phone:209-679-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health