Healthcare Provider Details

I. General information

NPI: 1467357400
Provider Name (Legal Business Name): MITCHELL DAVIS PALMER MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 W EMPIRE AVE
BURBANK CA
91504-3212
US

IV. Provider business mailing address

17800 BURBANK BLVD APT 304
ENCINO CA
91316-1665
US

V. Phone/Fax

Practice location:
  • Phone: 818-639-3568
  • Fax:
Mailing address:
  • Phone: 818-370-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: