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Provider Information for 1770003642


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Mr. LARRY ALLISON WARREN Jr.


Sex: Male

NPI: 1770003642
Last Updated: 2018-03-17
Certification Date:

Details

NameValue
NPI1770003642
Enumeration Date2017-06-22
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address PO BOX 161585
ALTAMONTE SPRINGS, FL 32716-1585
United States

Phone: 407-291-8009 | Fax:407-770-5503
 
Primary Practice Address 3544 EDGEWATER DR
ORLANDO, FL 32804-2922
United States

Phone: 407-291-8009 | Fax:407-770-5503
 
Secondary Practice Address(es)

3544 EDGEWATER DR
ORLANDO, FL 32804-2922
United States

Phone: 407-291-8009 | Fax:407-770-5503
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental Health