Basic Information
| Provider Information | |||||||||
| NPI: | 1669658605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARREN | ||||||||
| FirstName: | MARY-JANE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 W 38TH ST STE 318 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787316406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122033588 | ||||||||
| FaxNumber: | 5129570156 | ||||||||
| Practice Location | |||||||||
| Address1: | 3625 MANCHACA RD | ||||||||
| Address2: | #303 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787046631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123287222 | ||||||||
| FaxNumber: | 5123288222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2008 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 513149 | TX | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 513149 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.