Provider Demographics
NPI:1851843080
Name:PALMER, GABRIELLE ANNE (LPCC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANNE
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 1:2320 HIGHWAY 12 E
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-5811
Mailing Address - Country:US
Mailing Address - Phone:320-214-9692
Mailing Address - Fax:320-214-9924
Practice Address - Street 1:2320 HIGHWAY 12 E
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5811
Practice Address - Country:US
Practice Address - Phone:320-214-9692
Practice Address - Fax:320-214-9924
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01357101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor