Provider Demographics
NPI:1205353208
Name:PALMER, NICOLE M (MA, TLPC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:PALMER
Suffix:
Gender:F
Credentials:MA, TLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11770 S SHANNAN ST APT 313
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3693
Mailing Address - Country:US
Mailing Address - Phone:913-209-1845
Mailing Address - Fax:
Practice Address - Street 1:14201 S MUR LEN RD STE 101
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1859
Practice Address - Country:US
Practice Address - Phone:913-209-1845
Practice Address - Fax:913-273-0084
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional