1467072157 NPI number — ASHLEY SHAUNTE WARREN LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467072157 NPI number — ASHLEY SHAUNTE WARREN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARREN
Provider First Name:
ASHLEY
Provider Middle Name:
SHAUNTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WARREN
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
SHAUNTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ASHLEY RICE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467072157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23621 SAGE VILLA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CANEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77357-2075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
197-290-3216
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6021 FAIRMONT PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77505-4040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-769-2238
Provider Business Practice Location Address Fax Number:
281-769-2164
Provider Enumeration Date:
04/22/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  7901 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7901 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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