Provider Demographics
NPI:1386154920
Name:PALMER, CHANCE D (LCDC)
Entity type:Individual
Prefix:MR
First Name:CHANCE
Middle Name:D
Last Name:PALMER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BUTTERNUT CT
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088-7233
Mailing Address - Country:US
Mailing Address - Phone:817-566-4783
Mailing Address - Fax:817-977-8316
Practice Address - Street 1:105 BUTTERNUT CT
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76088-7233
Practice Address - Country:US
Practice Address - Phone:817-566-4783
Practice Address - Fax:817-977-8316
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13609101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty