Provider Demographics
NPI:1568792547
Name:PALMER, MARIECHIA LASHAWN (PHD, LMFT, LPC, LADC)
Entity Type:Individual
Prefix:DR
First Name:MARIECHIA
Middle Name:LASHAWN
Last Name:PALMER
Suffix:
Gender:F
Credentials:PHD, LMFT, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 HONEYLOCUST DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-2115
Mailing Address - Country:US
Mailing Address - Phone:405-771-4496
Mailing Address - Fax:405-601-4579
Practice Address - Street 1:310 NE 28TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2806
Practice Address - Country:US
Practice Address - Phone:405-601-4565
Practice Address - Fax:405-601-4579
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1077106H00000X, 101YM0800X
OK5397101YP2500X
OK908101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200355540AMedicaid