Healthcare Provider Details

I. General information

NPI: 1609382464
Provider Name (Legal Business Name): MICHAEL WARNER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 FOREST LAKE DR STE 100
GREEN OH
44685-8115
US

IV. Provider business mailing address

4095 GEPHART AVE
LOUISVILLE OH
44641-9337
US

V. Phone/Fax

Practice location:
  • Phone: 330-703-0105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2607868
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: