Provider Demographics
NPI:1194349712
Name:PALMER, TINNA RANEA (T-LMSW)
Entity type:Individual
Prefix:
First Name:TINNA
Middle Name:RANEA
Last Name:PALMER
Suffix:
Gender:F
Credentials:T-LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-2141
Mailing Address - Country:US
Mailing Address - Phone:785-543-5284
Mailing Address - Fax:
Practice Address - Street 1:783 7TH ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661-2141
Practice Address - Country:US
Practice Address - Phone:785-543-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker