Provider Demographics
NPI:1891205480
Name:WARREN, COURTNEY ANN (LMHC, MHP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:WARREN
Suffix:
Gender:F
Credentials:LMHC, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SOUTHCENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2547
Mailing Address - Country:US
Mailing Address - Phone:206-901-2000
Mailing Address - Fax:
Practice Address - Street 1:9575 ETHAN WADE WAY SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9577
Practice Address - Country:US
Practice Address - Phone:425-831-5425
Practice Address - Fax:425-831-5428
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60920961101YM0800X
WAMC60422285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2135244Medicaid