Provider Demographics
NPI:1871004549
Name:WARREN, PAULA SUSANN
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:SUSANN
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 S 20TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-2950
Mailing Address - Country:US
Mailing Address - Phone:269-359-1066
Mailing Address - Fax:
Practice Address - Street 1:71 S 20TH ST STE 102
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-2950
Practice Address - Country:US
Practice Address - Phone:269-359-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional