MEDICARE: PALMETTO SUPPORTIVE SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	101YS0200X	School Counselor
5	103K00000X	Behavior Analyst
6	106H00000X	Marriage & Family Therapist
7	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1518358696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO SUPPORTIVE SERVICES

Provider Business Mailing Address
First Line	:	25 WOODS LAKE RD STE 301
Second Line	:	SUITE 301
City	:	GREENVILLE
State	:	SC
Zip	:	29607-2762
Country	:	US
Telephone Number	:	864-346-2800
Fax Number	:	864-272-1974

Provider Business Practice Location Address
First Line	:	25 WOODS LAKE RD STE 301
Second Line	:	SUITE 301
City	:	GREENVILLE
State	:	SC
Zip	:	29607-2762
Country	:	US
Telephone Number	:	864-346-2800
Fax Number	:	864-272-1974

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. VICTOR AUSTIN JR.
Credential	:
Telephone Number	:	864-346-2800

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	02/11/2015

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