Provider Demographics
NPI:1821327347
Name:WARNER, LARRY EVERETT (MA, LLP)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:EVERETT
Last Name:WARNER
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 E MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9604
Mailing Address - Country:US
Mailing Address - Phone:231-347-9880
Mailing Address - Fax:231-347-9313
Practice Address - Street 1:2236 E MITCHELL RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9604
Practice Address - Country:US
Practice Address - Phone:231-347-9880
Practice Address - Fax:231-347-9313
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical