MEDICARE: MRS. KRISTIN M PALMER MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC53532	CA
2	106H00000X	Marriage & Family Therapist	5745547-3902	UT

General Provider Information

NPI Number	:	1033502760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN M PALMER MS

Provider Business Mailing Address
First Line	:	191 SAND CREEK RD
Second Line	:	SUITE 202F
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2215
Country	:	US
Telephone Number	:	925-301-3360
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 SAND CREEK RD
Second Line	:	SUITE 202F
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2215
Country	:	US
Telephone Number	:	925-301-3360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	03/05/2015

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