MEDICARE: MR. JOHN C. PALMER LCSW

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	28129	TX

General Provider Information

NPI Number	:	1902970882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN C. PALMER LCSW

Provider Business Mailing Address
First Line	:	1112 SAN AUGUSTINE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78733-2562
Country	:	US
Telephone Number	:	512-413-9219
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S MO PAC EXPY
Second Line	:	BLDG. 1, STE, 480
City	:	AUSTIN
State	:	TX
Zip	:	78746-5776
Country	:	US
Telephone Number	:	512-413-9219
Fax Number	:	512-329-0231

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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