Provider Demographics
NPI:1992054290
Name:PALMER, JEANETTE CULLIP (MS)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:CULLIP
Last Name:PALMER
Suffix:
Gender:F
Credentials:MS
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 122
Mailing Address - Street 2:480 DOLPHIN
Mailing Address - City:PORT SAINT JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32457-0122
Mailing Address - Country:US
Mailing Address - Phone:954-815-1696
Mailing Address - Fax:
Practice Address - Street 1:480 DOLPHIN ST.
Practice Address - Street 2:
Practice Address - City:ST. JOE
Practice Address - State:FL
Practice Address - Zip Code:32457
Practice Address - Country:US
Practice Address - Phone:954-815-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health