Provider Demographics
NPI:1669658605
Name:WARREN, MARY-JANE (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:MARY-JANE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W 38TH ST STE 318
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6406
Mailing Address - Country:US
Mailing Address - Phone:512-203-3588
Mailing Address - Fax:512-957-0156
Practice Address - Street 1:3625 MANCHACA RD
Practice Address - Street 2:#303
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6631
Practice Address - Country:US
Practice Address - Phone:512-328-7222
Practice Address - Fax:512-328-8222
Is Sole Proprietor?:No
Enumeration Date:2008-01-19
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513149163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health