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General NPI Number Information
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NPI Number | 1396901757
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Entity Type | Individual
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Provider Name | DERICK B PALMER ED.D, LPC, LMHC, NCC
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 9730 HIGHWAY 238
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9601
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Country | US
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Telephone | 541-841-8591
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Fax |
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Provider Business Mailing Address
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Address Line | 9730 HIGHWAY 238
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9601
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Country | US
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Telephone | 541-841-8591
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | RC60018183
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60210091
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 713
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License Number State | AK
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