Healthcare Provider Details

I. General information

NPI: 1790377596
Provider Name (Legal Business Name): KARLA LEIGH PALMER MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 15TH ST STE C
LOS ALAMOS NM
87544-3000
US

IV. Provider business mailing address

3 KAREN CIR
WHITE ROCK NM
87547-3797
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-4160
  • Fax:
Mailing address:
  • Phone: 505-709-7403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0215471
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: