Provider Demographics
NPI:1407555915
Name:WARREN, THERSSA JOANN
Entity Type:Individual
Prefix:MS
First Name:THERSSA
Middle Name:JOANN
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 ACCLAMATION ST E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-3886
Mailing Address - Country:US
Mailing Address - Phone:253-359-4051
Mailing Address - Fax:
Practice Address - Street 1:417 E PIONEER STE B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3267
Practice Address - Country:US
Practice Address - Phone:253-285-8673
Practice Address - Fax:253-785-9945
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health