Provider Demographics
NPI:1508183492
Name:PALMER, JERALD WHITNEY (LCPC)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:WHITNEY
Last Name:PALMER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 2ND AVE N STE 614
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3287
Mailing Address - Country:US
Mailing Address - Phone:406-231-3064
Mailing Address - Fax:406-952-4631
Practice Address - Street 1:1601 2ND AVE N STE 614
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3287
Practice Address - Country:US
Practice Address - Phone:406-231-3064
Practice Address - Fax:406-952-4631
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional