Provider Demographics
NPI:1235765330
Name:PALMER, TIMOTHY GARR (LCSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GARR
Last Name:PALMER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 JOHNNY CREEK RD APT B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4455
Mailing Address - Country:US
Mailing Address - Phone:208-241-8308
Mailing Address - Fax:
Practice Address - Street 1:400 S 11TH AVE
Practice Address - Street 2:STE 204
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-232-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-434741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical