Healthcare Provider Details

I. General information

NPI: 1770643520
Provider Name (Legal Business Name): CAROL WARNER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 J W DR SUITE D
CARBONDALE CO
81623-7739
US

IV. Provider business mailing address

189 J W DR SUITE D
CARBONDALE CO
81623-7739
US

V. Phone/Fax

Practice location:
  • Phone: 970-920-7683
  • Fax: 970-963-9411
Mailing address:
  • Phone: 970-920-7683
  • Fax: 970-963-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number320
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: