Provider Demographics
NPI:1750880282
Name:WARREN, KERI LYNN (PHD, DMIN, MA, BS)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:LYNN
Last Name:WARREN
Suffix:
Gender:F
Credentials:PHD, DMIN, MA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-1151
Mailing Address - Country:US
Mailing Address - Phone:734-709-1460
Mailing Address - Fax:
Practice Address - Street 1:1945 PAULINE BLVD STE 10
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5047
Practice Address - Country:US
Practice Address - Phone:734-709-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006598106H00000X
MI6401014010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty