Provider Demographics
NPI:1396901757
Name:PALMER, DERICK B (EDD, LPC, LMHC, NCC)
Entity type:Individual
Prefix:MR
First Name:DERICK
Middle Name:B
Last Name:PALMER
Suffix:
Gender:M
Credentials:EDD, LPC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9730 HIGHWAY 238
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9601
Mailing Address - Country:US
Mailing Address - Phone:541-841-8591
Mailing Address - Fax:
Practice Address - Street 1:9730 HIGHWAY 238
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9601
Practice Address - Country:US
Practice Address - Phone:541-841-8591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60018183101Y00000X
WALH60210091101YM0800X
AK713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health