Provider Demographics
NPI:1679619050
Name:WARRUS, AUDREY PATRICIA (MA LP & LMFT)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:PATRICIA
Last Name:WARRUS
Suffix:
Gender:F
Credentials:MA LP & LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FIRST AVE N
Mailing Address - Street 2:SUITE B10
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2255
Mailing Address - Country:US
Mailing Address - Phone:763-422-8135
Mailing Address - Fax:763-422-1943
Practice Address - Street 1:2006 FIRST AVE N
Practice Address - Street 2:SUITE B10
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2255
Practice Address - Country:US
Practice Address - Phone:763-422-8135
Practice Address - Fax:763-422-1943
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0165103TC0700X
MNLMFT0754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00021Medicaid
53193727OtherUBH ONLINE USER NO
00720OtherBCBS PIN NO
6264783OtherMEDICA
6C49SWAOtherBCBS ID NO
MN535248700Medicaid
6C494WAOtherBCBS GROUP NO
53193727OtherUBH ONLINE USER NO
MN535248700Medicaid