Provider Demographics
NPI:1902970882
Name:PALMER, JOHN C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:PALMER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 SAN AUGUSTINE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-2562
Mailing Address - Country:US
Mailing Address - Phone:512-413-9219
Mailing Address - Fax:
Practice Address - Street 1:901 S MO PAC EXPY
Practice Address - Street 2:BLDG. 1, STE, 480
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5776
Practice Address - Country:US
Practice Address - Phone:512-413-9219
Practice Address - Fax:512-329-0231
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health