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NPI Code Detail

MEDICARE: MR. RONALD CHARLES PALMER JR. LPC

MEDICARE: MR. RONALD CHARLES PALMER JR. LPC
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
1101YM0800XMental Health Counselor69841TX

General Provider Information

NPI Number : 1164825998
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD CHARLES PALMER JR. LPC
Provider Business Mailing Address
First Line : 9702 FALCON BAY
Second Line :
City : CONVERSE
State : TX
Zip : 78109-2940
Country : US
Telephone Number : 210-557-4188
Fax Number :
Provider Business Practice Location Address
First Line : 4201 MEDICAL DR STE 330
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-5805
Country : US
Telephone Number : 210-614-4990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2014
Last Update Date : 10/07/2014

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