1619495371 NPI number — SHELIA ANN PALMER SUD COUNSELOR II

Table of content: SHELIA ANN PALMER SUD COUNSELOR II (NPI 1619495371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619495371 NPI number — SHELIA ANN PALMER SUD COUNSELOR II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMER
Provider First Name:
SHELIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SUD COUNSELOR II
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619495371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20228 DALFSEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90746-2934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-384-4907
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 E HARRY BRIDGES BLVD # A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90744-5825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-384-4907
Provider Business Practice Location Address Fax Number:
310-835-1202
Provider Enumeration Date:
09/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CI31750121 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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