Provider Demographics
NPI:1386391126
Name:PALMER, TYNESHA
Entity type:Individual
Prefix:
First Name:TYNESHA
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 OCOEE ST N STE 8
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4886
Mailing Address - Country:US
Mailing Address - Phone:423-244-4050
Mailing Address - Fax:
Practice Address - Street 1:4160 OCOEE ST N STE 8
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4886
Practice Address - Country:US
Practice Address - Phone:423-464-4357
Practice Address - Fax:423-464-4364
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health