MEDICARE: MRS. NICOLE MARIE WARREN MS

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	106H00000X	Marriage & Family Therapist	202085	TX

General Provider Information

NPI Number	:	1891852026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE MARIE WARREN MS

Provider Business Mailing Address
First Line	:	1508 DESSAU RIDGE LN STE 204
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-2190
Country	:	US
Telephone Number	:	512-553-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 DESSAU RIDGE LN STE 204
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-2190
Country	:	US
Telephone Number	:	512-553-2054
Fax Number	:

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/12/2019

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