Provider Demographics
NPI:1639998925
Name:PALMORE, MONICA ALISE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ALISE
Last Name:PALMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7274 W MUSTANG DR
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-1207
Mailing Address - Country:US
Mailing Address - Phone:810-845-7262
Mailing Address - Fax:
Practice Address - Street 1:389 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1503
Practice Address - Country:US
Practice Address - Phone:765-342-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10214290103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool