Basic Information
| Provider Information | |||||||||
| NPI: | 1306110788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALMER | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 628 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | CARLETON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481179113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179188089 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20500 EUREKA RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481806394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342858282 | ||||||||
| FaxNumber: | 7342810402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2012 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401011895 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 6401017872 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101Y00000X | 6401017872 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.