Provider Demographics
NPI:1194030379
Name:WARNICK, KRISTAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:KRISTAN
Middle Name:
Last Name:WARNICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KRISTAN
Other - Middle Name:
Other - Last Name:WARNICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1390 S 1100 E
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2461
Mailing Address - Country:US
Mailing Address - Phone:801-867-8112
Mailing Address - Fax:
Practice Address - Street 1:1390 S 1100 E
Practice Address - Street 2:SUITE 201A
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2461
Practice Address - Country:US
Practice Address - Phone:801-867-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5533760-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional