Provider Demographics
NPI:1033502760
Name:PALMER, KRISTIN M (MS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:M
Last Name:PALMER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SAND CREEK RD
Mailing Address - Street 2:SUITE 202F
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2215
Mailing Address - Country:US
Mailing Address - Phone:925-301-3360
Mailing Address - Fax:
Practice Address - Street 1:191 SAND CREEK RD
Practice Address - Street 2:SUITE 202F
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2215
Practice Address - Country:US
Practice Address - Phone:925-301-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53532106H00000X
UT5745547-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist