Provider Demographics
NPI:1053969360
Name:WARREN, MISTY D (LIMHP)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:D
Last Name:WARREN
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16707 Q ST STE D
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1248
Mailing Address - Country:US
Mailing Address - Phone:402-670-8850
Mailing Address - Fax:
Practice Address - Street 1:16707 Q ST STE D
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1248
Practice Address - Country:US
Practice Address - Phone:402-670-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2607101Y00000X, 101YM0800X
NE11977101YM0800X
IA100111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor