Provider Demographics
NPI:1073648689
Name:WARNER, MELISSA R (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:WARNER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21192 N 80TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-4415
Mailing Address - Country:US
Mailing Address - Phone:602-332-8523
Mailing Address - Fax:
Practice Address - Street 1:6833 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8453
Practice Address - Country:US
Practice Address - Phone:623-878-2037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5852T101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor