Provider Demographics
NPI:1063866549
Name:PALMER, DUSTIN (LCSW)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 E 9400 S STE 201
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3676
Mailing Address - Country:US
Mailing Address - Phone:801-251-6449
Mailing Address - Fax:
Practice Address - Street 1:880 E 9400 S STE 201
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3676
Practice Address - Country:US
Practice Address - Phone:801-251-6449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
UT9431546-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor