MEDICARE: PANDORA KAY PALMER L.C.P.C., C.R.C

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	101YP2500X	Professional Counselor	SWP-LCPC-LIC-7854	MT
2	225C00000X	Rehabilitation Counselor	00111462	MT

General Provider Information

NPI Number	:	1073925350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PANDORA KAY PALMER L.C.P.C., C.R.C

Provider Business Mailing Address
First Line	:	3720 HAYDEN DR
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-1129
Country	:	US
Telephone Number	:	406-698-0020
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 N 19TH ST
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-1426
Country	:	US
Telephone Number	:	406-698-1587
Fax Number	:	406-656-0935

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

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	09/10/2014

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