Provider Demographics
NPI:1649353467
Name:WARREN, J LEWIS (D MIN, L M H P)
Entity type:Individual
Prefix:DR
First Name:J
Middle Name:LEWIS
Last Name:WARREN
Suffix:
Gender:M
Credentials:D MIN, L M H P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 21ST ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-2625
Mailing Address - Country:US
Mailing Address - Phone:308-436-3640
Mailing Address - Fax:
Practice Address - Street 1:955 COUNTRY CLUB RD # B4
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1765
Practice Address - Country:US
Practice Address - Phone:308-635-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health