Provider Demographics
NPI:1265323786
Name:PALMER, MARTIN AFELE (AMFT)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:AFELE
Last Name:PALMER
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E CENTER ST STE 309
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3154
Mailing Address - Country:US
Mailing Address - Phone:509-761-9961
Mailing Address - Fax:
Practice Address - Street 1:1 E CENTER STREET
Practice Address - Street 2:SUITE 309
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3154
Practice Address - Country:US
Practice Address - Phone:509-761-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14080460-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist