Provider Demographics
NPI:1770954711
Name:PALMER, KARRIE (MFT)
Entity type:Individual
Prefix:
First Name:KARRIE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E CAMPBELL AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2049
Mailing Address - Country:US
Mailing Address - Phone:408-806-0983
Mailing Address - Fax:
Practice Address - Street 1:155 E CAMPBELL AVE STE 107
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2049
Practice Address - Country:US
Practice Address - Phone:408-806-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50949101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45-4967047OtherEIN NUMBER