Basic Information
Provider Information
NPI: 1053644815
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WARNER
FirstName: HELEN
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 220 RUSKIN DR
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 809102522
CountryCode: US
TelephoneNumber: 7195726100
FaxNumber:  
Practice Location
Address1: 875 W MORENO AVE
Address2:  
City: COLORADO SPRINGS
State: CO
PostalCode: 809051731
CountryCode: US
TelephoneNumber: 7195726200
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/11/2009
LastUpdateDate: 09/11/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X  Y Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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