Provider Demographics
NPI:1881710879
Name:WARNER-LONG, KATHLEEN JOAN (MED, LCPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JOAN
Last Name:WARNER-LONG
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JOAN
Other - Last Name:WARNER-BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LCPC
Mailing Address - Street 1:506 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801
Mailing Address - Country:US
Mailing Address - Phone:620-227-8566
Mailing Address - Fax:620-225-5824
Practice Address - Street 1:506 AVENUE L
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-227-8566
Practice Address - Fax:620-225-5824
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407449100Medicaid