Provider Demographics
NPI:1942503461
Name:PALMER, LARAMIE LEON
Entity Type:Individual
Prefix:MR
First Name:LARAMIE
Middle Name:LEON
Last Name:PALMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 SOUTH HIGHWAY 69
Mailing Address - Street 2:WAGONER
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74464
Mailing Address - Country:US
Mailing Address - Phone:918-284-5076
Mailing Address - Fax:918-756-2126
Practice Address - Street 1:2109 SOUTH HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-284-5076
Practice Address - Fax:918-756-2126
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor