Provider Demographics
NPI:1518048529
Name:PALMER, ROLAND LAVELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:LAVELLE
Last Name:PALMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 N UNIVERSITY BLVD.
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069
Mailing Address - Country:US
Mailing Address - Phone:405-447-0470
Mailing Address - Fax:405-447-7087
Practice Address - Street 1:1090 N UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7620
Practice Address - Country:US
Practice Address - Phone:405-447-0470
Practice Address - Fax:405-447-7087
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK640103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral