MEDICARE: MRS. JEANNIE LYNN WARREN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1194894048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNIE LYNN WARREN

Provider Business Mailing Address
First Line	:	3218 PINE FOREST DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1835
Country	:	US
Telephone Number	:	618-444-8761
Fax Number	:

Provider Business Practice Location Address
First Line	:	3218 PINE FOREST DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1835
Country	:	US
Telephone Number	:	618-444-8761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	02/04/2024

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