| Doctor Name: | KERRY D WARREN |
| NPI Number: | 1275756629 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MBS, LPC, LADC, CM |
| License Number: | 840 |
| Business Practice Address: | 14 N.e. Mlk Ave Idabel, OK - 74745 |
| Business Phone Number: | 5802865777 |
| Business Fax Number: | |
| Mailing Address: | Po Box 673, VALLIANT |
| State: | OK |
| Postal Code: | 747640673 |
| Phone Number: | 5809337031 |
| Fax Number: | |
| NPI Enumeration Date: | 04/11/2007 |
| NPI Last Update Date: | 02/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 840 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |