Healthcare Provider Details

I. General information

NPI: 1831867571
Provider Name (Legal Business Name): DYANI PALMER LPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 S TRENTON AVE
TULSA OK
74120-5420
US

IV. Provider business mailing address

1005 E 67TH ST APT 1121
TULSA OK
74136-3743
US

V. Phone/Fax

Practice location:
  • Phone: 918-586-4292
  • Fax:
Mailing address:
  • Phone: 620-952-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCANDIDATE13429
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: