Healthcare Provider Details

I. General information

NPI: 1710395629
Provider Name (Legal Business Name): KELSEY PALMER NCC, LPC-MH, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 KANSAS AVE SE
HURON SD
57350-2517
US

IV. Provider business mailing address

357 KANSAS AVE SE
HURON SD
57350-2517
US

V. Phone/Fax

Practice location:
  • Phone: 53-528-5966
  • Fax: 605-352-7001
Mailing address:
  • Phone: 605-352-8596
  • Fax: 605-352-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT1231
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-MH30504
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: