Michael Warren

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CTB-2023-0545 Issued in NM

Practice address

PO Box 1490
Fort Defiance, AZ 86504-1490

Phone

(928) 729-4012

NPI assigned

Jun 12, 2024

Last updated

Jun 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fort Defiance Outpatient Treatment Center

  • Community/Behavioral Health Agency
  • Fort Defiance, AZ
  • NPI 1740400365
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1679315303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1490",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865041490",
            "telephone_number": "928-729-4012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 1490",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865041490",
            "telephone_number": "928-729-4012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-12",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NM",
            "license": "CTB-2023-0545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wagon Express Professional Transport, LLC
• Wagon Trail Professional Transport LLC
• Tyrone Harold Walker, M.D.
• Melissa Marie Walters, OD
• Christopher Warren, DO
• Lucinda M Waseta, LMSW
• Darreika Eva Washington, FNP-C
• Jenifer Washington
• David Glen Webb, PHARMD
• Katherine Wegman

• Counselor in Fort Defiance, AZ
• Providers in Fort Defiance, AZ by specialty
• Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.