Provider Demographics
NPI:1912108283
Name:PALMER, REBECA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECA
Middle Name:A
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N HUNTERS BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-7239
Mailing Address - Country:US
Mailing Address - Phone:916-335-7857
Mailing Address - Fax:
Practice Address - Street 1:4200 PERIMETER CENTER DR
Practice Address - Street 2:SUITE #245
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2324
Practice Address - Country:US
Practice Address - Phone:916-335-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58021041C0700X
CA245911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24591OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES
OK5802OtherOKLAHOMA STATE BOARD OF LICENSED SOCIAL WORKERS