MEDICARE: SANDRA J PALMER LMHC

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	LMHC7305	FL

General Provider Information

NPI Number	:	1760762306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA J PALMER LMHC

Provider Business Mailing Address
First Line	:	8165 FRESH CRK
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-5508
Country	:	US
Telephone Number	:	561-315-7633
Fax Number	:

Provider Business Practice Location Address
First Line	:	8165 FRESH CRK
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-5508
Country	:	US
Telephone Number	:	561-315-7633
Fax Number	:

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

Provider Enumeration Date	:	08/26/2011
Last Update Date	:	08/26/2011

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