Provider Demographics
NPI:1376928333
Name:PEACE-PALMER, PERRY G (PHD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:G
Last Name:PEACE-PALMER
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:DR
Other - First Name:PERRY
Other - Middle Name:G
Other - Last Name:PEACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LMHC
Mailing Address - Street 1:2631 NW 41ST ST
Mailing Address - Street 2:STE E-6
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7470
Mailing Address - Country:US
Mailing Address - Phone:352-870-5230
Mailing Address - Fax:
Practice Address - Street 1:2631 NW 41ST ST
Practice Address - Street 2:STE E-6
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7470
Practice Address - Country:US
Practice Address - Phone:352-870-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health