Basic Information
| Provider Information | |||||||||
| NPI: | 1821327347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARNER | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | EVERETT | ||||||||
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| Credential: | MA, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2236 E MITCHELL RD | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497709604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2313479880 | ||||||||
| FaxNumber: | 2313479313 | ||||||||
| Practice Location | |||||||||
| Address1: | 2236 E MITCHELL RD | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497709604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2313479880 | ||||||||
| FaxNumber: | 2313479313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2009 | ||||||||
| LastUpdateDate: | 12/11/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301003176 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.