Provider Demographics
NPI:1467571174
Name:PALMER, KIM MICHAELE (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:MICHAELE
Last Name:PALMER
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2836
Mailing Address - Country:US
Mailing Address - Phone:801-388-1489
Mailing Address - Fax:
Practice Address - Street 1:4231 PORTER AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2836
Practice Address - Country:US
Practice Address - Phone:801-388-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376369-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional