MEDICARE: MRS. ELIZABETH WARNER MS LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1295724672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH WARNER MS LCPC

Provider Business Mailing Address
First Line	:	7 GLEN ED PROFESSIONAL PARK
Second Line	:
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-3333
Country	:	US
Telephone Number	:	618-692-0336
Fax Number	:	618-692-0353

Provider Business Practice Location Address
First Line	:	7 GLEN ED PROFESSIONAL PARK
Second Line	:
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-3333
Country	:	US
Telephone Number	:	618-692-0336
Fax Number	:	618-692-0353

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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