Provider Demographics
NPI:1447893177
Name:WARRICK, DEMI ALLISON
Entity type:Individual
Prefix:
First Name:DEMI
Middle Name:ALLISON
Last Name:WARRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 N. HWY 160
Mailing Address - Street 2:SUITES 600 - 700
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-1619
Mailing Address - Country:US
Mailing Address - Phone:775-505-1625
Mailing Address - Fax:
Practice Address - Street 1:2050 N. HWY 160
Practice Address - Street 2:SUITES 600 - 700
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-1619
Practice Address - Country:US
Practice Address - Phone:775-505-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01501-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2004817247Medicaid