Provider Demographics
NPI:1043418098
Name:WARREN BEHAVIORAL CARE, INC
Entity Type:Organization
Organization Name:WARREN BEHAVIORAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNELLE
Authorized Official - Middle Name:LEKOYNE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-808-8991
Mailing Address - Street 1:PO BOX 952
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-0952
Mailing Address - Country:US
Mailing Address - Phone:334-808-8991
Mailing Address - Fax:334-808-8995
Practice Address - Street 1:889 ELBA HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36079-6017
Practice Address - Country:US
Practice Address - Phone:334-808-8991
Practice Address - Fax:334-808-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1357103TC0700X
GAPSY003090103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL61-00470OtherUNITED HEALTHCARE SERVICE
AL=========OtherTRICARE SOUTH
ALK785Medicare PIN