Provider Demographics
NPI:1427409507
Name:PALMER, CALLIE DEEANN
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:DEEANN
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 S AMPHLETT BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2514
Mailing Address - Country:US
Mailing Address - Phone:650-877-8642
Mailing Address - Fax:
Practice Address - Street 1:1650 S AMPHLETT BLVD STE 113
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2514
Practice Address - Country:US
Practice Address - Phone:650-877-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC4923101YM0800X
CAAMFT105474106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health