MEDICARE: LUIS ALEJANDRO PALMA III CCHT, RMT

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	101Y00000X	Counselor
2	174400000X	Specialist

General Provider Information

NPI Number	:	1578944104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS ALEJANDRO PALMA III CCHT, RMT

Provider Business Mailing Address
First Line	:	137 CEDAR ST
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28115-2666
Country	:	US
Telephone Number	:	704-604-6117
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 JOE KNOX AVE
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9169
Country	:	US
Telephone Number	:	704-604-6117
Fax Number	:

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

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	06/09/2015

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