Provider Demographics
NPI:1639287014
Name:PALMER, MELISSA A (LPCC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:PALMER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 DEMOSS ST
Mailing Address - Street 2:
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2618
Mailing Address - Country:US
Mailing Address - Phone:575-388-4412
Mailing Address - Fax:575-313-8236
Practice Address - Street 1:1720 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-8304
Practice Address - Country:US
Practice Address - Phone:575-388-4412
Practice Address - Fax:575-313-8236
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0137441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29604036Medicaid
NM29604036Medicaid