Healthcare Provider Details

I. General information

NPI: 1255494126
Provider Name (Legal Business Name): CAROL ELIZABETH WARREN MSW, CMHS, MHP, RC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SHELTON MCMURPHEY BLVD
EUGENE OR
97401
US

IV. Provider business mailing address

10 SHELTON MCMURPHEY BLVD
EUGENE OR
97401-4928
US

V. Phone/Fax

Practice location:
  • Phone: 206-276-0883
  • Fax:
Mailing address:
  • Phone: 206-276-0883
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-19-001
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00052955
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500757201
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: