Healthcare Provider Details

I. General information

NPI: 1821388810
Provider Name (Legal Business Name): HENRY PALMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 S DURANGO DR SUITE 207
LAS VEGAS NV
89113-0152
US

IV. Provider business mailing address

5155 W TROPICANA AVE UNIT 1077
LAS VEGAS NV
89103-7058
US

V. Phone/Fax

Practice location:
  • Phone: 702-650-6508
  • Fax: 702-893-9655
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: