Healthcare Provider Details

I. General information

NPI: 1194561407
Provider Name (Legal Business Name): HEATHER WARREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 FAIRGROVE AVE STE E
HAMILTON OH
45011-1966
US

IV. Provider business mailing address

1900 FAIRGROVE AVE STE E
HAMILTON OH
45011-1966
US

V. Phone/Fax

Practice location:
  • Phone: 513-795-7557
  • Fax:
Mailing address:
  • Phone: 513-795-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2405645-TRNE
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2506993
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: