Provider Demographics
NPI:1104343805
Name:PALMITIER, JACY ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:JACY
Middle Name:ANN
Last Name:PALMITIER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 FM 2252 SUITE 15
Mailing Address - Street 2:
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266
Mailing Address - Country:US
Mailing Address - Phone:704-682-5178
Mailing Address - Fax:210-281-5108
Practice Address - Street 1:19115 FM 2252 SUITE 15
Practice Address - Street 2:
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266
Practice Address - Country:US
Practice Address - Phone:704-682-5178
Practice Address - Fax:210-281-5108
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71551101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health