Provider Demographics
NPI:1578188975
Name:WARREN, ELIZABETH MARIE (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:WARREN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:4721 S. CLIFF. AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055
Mailing Address - Country:US
Mailing Address - Phone:816-368-8120
Mailing Address - Fax:800-687-5070
Practice Address - Street 1:4721 S. CLIFF. AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:816-368-8120
Practice Address - Fax:800-687-5070
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20-110886106S00000X
MO15-78188975106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician