Healthcare Provider Details

I. General information

NPI: 1306110788
Provider Name (Legal Business Name): PATRICIA ANN PALMER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20500 EUREKA RD STE 200
TAYLOR MI
48180-6394
US

IV. Provider business mailing address

628 WALNUT ST
CARLETON MI
48117-9113
US

V. Phone/Fax

Practice location:
  • Phone: 734-285-8282
  • Fax: 734-281-0402
Mailing address:
  • Phone: 517-918-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011895
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017872
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401017872
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: