Provider Demographics
NPI:1093214553
Name:PALMER COUNSELING CONSULTING COACHING INCORPORATED
Entity Type:Organization
Organization Name:PALMER COUNSELING CONSULTING COACHING INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING & CREDENTIALING SPE
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-833-8615
Mailing Address - Street 1:9702 FALCON BAY
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2940
Mailing Address - Country:US
Mailing Address - Phone:210-826-9599
Mailing Address - Fax:210-826-9828
Practice Address - Street 1:3030 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4540
Practice Address - Country:US
Practice Address - Phone:210-826-9599
Practice Address - Fax:210-826-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339437102Medicaid