MEDICARE: LISA PALMER

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	101YM0800X	Mental Health Counselor	PROFESSIONALLICENSE

General Provider Information

NPI Number	:	1528426970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA PALMER

Provider Business Mailing Address
First Line	:	3587 HEATHROW WAY
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-4004
Country	:	US
Telephone Number	:	541-858-8170
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 MANZANITA ST
Second Line	:
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-2352
Country	:	US
Telephone Number	:	541-423-5236
Fax Number	:	541-423-5248

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

Provider Enumeration Date	:	01/31/2016
Last Update Date	:	11/14/2023

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Directions to “ LISA PALMER ” Practice Location

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