Provider Demographics
NPI:1669719324
Name:PALMER, DUSTIN ALAN (MSW)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:ALAN
Last Name:PALMER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7916
Mailing Address - Country:US
Mailing Address - Phone:918-946-6233
Mailing Address - Fax:
Practice Address - Street 1:7125 S BRADEN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6302
Practice Address - Country:US
Practice Address - Phone:918-481-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical