Basic Information
| Provider Information | |||||||||
| NPI: | 1003015637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARNER | ||||||||
| FirstName: | NICK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S FARRELL DR | ||||||||
| Address2: | SUITE B-201 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922627965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608988872 | ||||||||
| FaxNumber: | 8883926660 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S FARRELL DR | ||||||||
| Address2: | SUITE B-201 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922627965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608988872 | ||||||||
| FaxNumber: | 8883926660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 12/30/2011 | ||||||||
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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 | 106H00000X | MFT13007 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.