Provider Demographics
NPI:1073807038
Name:WARREN, TIMOTHY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WARREN
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-4117
Mailing Address - Country:US
Mailing Address - Phone:402-707-7924
Mailing Address - Fax:402-707-7924
Practice Address - Street 1:801 ROBERTSON AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-2717
Practice Address - Country:US
Practice Address - Phone:402-707-7924
Practice Address - Fax:402-707-7924
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-592101Y00000X
WYLPC-1317101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106352907Medicaid
WY106352908Medicaid