Provider Demographics
NPI:1447423462
Name:PALMER, KRISTINA LARAE (LCPC CEDS)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LARAE
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCPC CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 E STATE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2342
Mailing Address - Country:US
Mailing Address - Phone:208-392-2762
Mailing Address - Fax:208-247-0873
Practice Address - Street 1:39 E STATE AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2342
Practice Address - Country:US
Practice Address - Phone:208-392-2762
Practice Address - Fax:208-247-0873
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3202101YA0400X
ID4502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)