Provider Demographics
NPI:1851999650
Name:PALM WELLNESS, LLC
Entity Type:Organization
Organization Name:PALM WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-212-1389
Mailing Address - Street 1:565 W BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1328
Mailing Address - Country:US
Mailing Address - Phone:440-212-1389
Mailing Address - Fax:
Practice Address - Street 1:565 W BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1328
Practice Address - Country:US
Practice Address - Phone:440-212-1389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0202676Medicaid