Healthcare Provider Details

I. General information

NPI: 1023058161
Provider Name (Legal Business Name): FERNELLE LEKOYNE WARREN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 ELBA HIGHWAY SUITE 107A
TROY AL
36079-6017
US

IV. Provider business mailing address

PO BOX 952
TROY AL
36081-0952
US

V. Phone/Fax

Practice location:
  • Phone: 334-808-8991
  • Fax: 334-808-8995
Mailing address:
  • Phone: 334-434-9019
  • Fax: 334-808-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1357
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: