Provider Demographics
NPI:1477936177
Name:WARNER, JACQUE
Entity Type:Individual
Prefix:
First Name:JACQUE
Middle Name:
Last Name:WARNER
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 1:1595 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4706
Mailing Address - Country:US
Mailing Address - Phone:928-329-5855
Mailing Address - Fax:928-329-5904
Practice Address - Street 1:1595 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4706
Practice Address - Country:US
Practice Address - Phone:928-329-5855
Practice Address - Fax:928-329-5904
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175T00000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health