Provider Demographics
NPI:1760135743
Name:KATHRYN WARREN,MA LLP
Entity Type:Organization
Organization Name:KATHRYN WARREN,MA LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:616-828-6827
Mailing Address - Street 1:2020 RAYBROOK ST SE STE 308
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7717
Mailing Address - Country:US
Mailing Address - Phone:616-649-1010
Mailing Address - Fax:616-551-2895
Practice Address - Street 1:2020 RAYBROOK ST SE STE 308
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7717
Practice Address - Country:US
Practice Address - Phone:616-649-1010
Practice Address - Fax:616-551-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty