Healthcare Provider Details

I. General information

NPI: 1639287014
Provider Name (Legal Business Name): MELISSA A PALMER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 294
GILA NM
88038-0294
US

IV. Provider business mailing address

PO BOX 294
GILA NM
88038-0294
US

V. Phone/Fax

Practice location:
  • Phone: 575-313-2194
  • Fax:
Mailing address:
  • Phone: 575-313-2194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0137441
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: