MEDICARE: PALM PSYCHOLOGICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1508722075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	1623 E SAINT LOUIS ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-3129
Country	:	US
Telephone Number	:	417-818-4187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 E SAINT LOUIS ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-3129
Country	:	US
Telephone Number	:	417-818-4187
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	MELODY DARLENE PALM
Credential	:	PSYD
Telephone Number	:	417-818-4187

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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