Healthcare Provider Details

I. General information

NPI: 1952551210
Provider Name (Legal Business Name): TRACY LYNN PALMER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 E BASELINE RD STE 109
MESA AZ
85206-4629
US

IV. Provider business mailing address

4864 E BASELINE RD STE 109
MESA AZ
85206-4629
US

V. Phone/Fax

Practice location:
  • Phone: 480-744-5088
  • Fax: 480-744-5088
Mailing address:
  • Phone: 480-744-5088
  • Fax: 480-992-4422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC12995
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLPC-12995
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: