Basic Information
| Provider Information | |||||||||
| NPI: | 1023482189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALOMO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5750 A SOUTHLAND DRIVE | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366933316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514502211 | ||||||||
| FaxNumber: | 2516627297 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N BISHOP LANE | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366085821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514502211 | ||||||||
| FaxNumber: | 2516627297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2015 | ||||||||
| LastUpdateDate: | 11/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3189 | AL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.