Provider Demographics
NPI:1699265827
Name:PALMER, KIMBERLY R
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
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 1:2659 E LIBRA ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3912
Mailing Address - Country:US
Mailing Address - Phone:602-512-5407
Mailing Address - Fax:
Practice Address - Street 1:690 E WARNER RD STE 115
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3056
Practice Address - Country:US
Practice Address - Phone:480-444-2434
Practice Address - Fax:480-588-8454
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC16147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health