Healthcare Provider Details

I. General information

NPI: 1801618848
Provider Name (Legal Business Name): BELINDA PALM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 STUBBS AVE
MONROE LA
71201-5622
US

IV. Provider business mailing address

112 LUKE DR
MONROE LA
71203-6769
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-8748
  • Fax: 318-325-8749
Mailing address:
  • Phone: 318-512-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4968
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: