Provider Demographics
NPI:1497428601
Name:WARREN, HEATHER JO (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JO
Last Name:WARREN
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N JOHNSON AVE STE P
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-2589
Mailing Address - Country:US
Mailing Address - Phone:619-441-1907
Mailing Address - Fax:
Practice Address - Street 1:700 N JOHNSON AVE STE P
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2589
Practice Address - Country:US
Practice Address - Phone:619-441-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT138423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist