Provider Demographics
NPI:1659738979
Name:PALMER, RICKIE (LPCC)
Entity Type:Individual
Prefix:
First Name:RICKIE
Middle Name:
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 1:500 MARQUETTE AVE NW
Mailing Address - Street 2:SUITE 1234
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-5340
Mailing Address - Country:US
Mailing Address - Phone:505-350-5139
Mailing Address - Fax:
Practice Address - Street 1:500 MARQUETTE AVE NW
Practice Address - Street 2:SUITE 1234
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-5340
Practice Address - Country:US
Practice Address - Phone:505-350-5139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0178511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health