Provider Demographics
NPI:1114779949
Name:WARNER, ANDREW (MED, PLPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WARNER
Suffix:
Gender:M
Credentials:MED, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 HIGHWAY 109
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1192
Mailing Address - Country:US
Mailing Address - Phone:314-833-7302
Mailing Address - Fax:
Practice Address - Street 1:2634 HIGHWAY 109
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:MO
Practice Address - Zip Code:63040-1192
Practice Address - Country:US
Practice Address - Phone:314-833-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023005048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health