Provider Demographics
NPI:1366600090
Name:PALKO, MARY PATRICIA (MSCP, LPC, CDCII)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:PALKO
Suffix:
Gender:F
Credentials:MSCP, LPC, CDCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:3760 PIPER ST STE 1108
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4683
Practice Address - Country:US
Practice Address - Phone:907-212-6900
Practice Address - Fax:907-212-6936
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPCOP503101YP2500X
AK503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional