Provider Demographics
NPI:1548678394
Name:WARREN, JOSHUA R (LPC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
Last Name:WARREN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:5242 PLAINFIELD AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1084
Mailing Address - Country:US
Mailing Address - Phone:616-308-6151
Mailing Address - Fax:
Practice Address - Street 1:5242 PLAINFIELD AVE NE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-308-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional