Provider Demographics
NPI:1184940520
Name:LISA R PALMER PLLC
Entity type:Organization
Organization Name:LISA R PALMER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PLLC
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:606-875-1130
Mailing Address - Street 1:PO BOX 744
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42502-0744
Mailing Address - Country:US
Mailing Address - Phone:606-875-1130
Mailing Address - Fax:606-678-0603
Practice Address - Street 1:110 RICHIE LN
Practice Address - Street 2:SUITE C
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-6128
Practice Address - Country:US
Practice Address - Phone:606-875-1130
Practice Address - Fax:606-678-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1238251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYM100018444Medicare PIN