Provider Demographics
NPI:1376912139
Name:PALMER, LORIE
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:
Other - Last Name:MANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSC, CAC III
Mailing Address - Street 1:1964 E 167TH LN
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11658 HURON ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2919
Practice Address - Country:US
Practice Address - Phone:303-252-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)