Provider Demographics
NPI:1437232568
Name:WARNER, JACKIE LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:LYNN
Last Name:WARNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-6230
Mailing Address - Country:US
Mailing Address - Phone:989-832-1625
Mailing Address - Fax:989-633-1039
Practice Address - Street 1:3611 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2384
Practice Address - Country:US
Practice Address - Phone:989-631-2323
Practice Address - Fax:989-633-1039
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional