Provider Demographics
NPI:1578376497
Name:PALMER, VANESSA E (ACLC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:E
Last Name:PALMER
Suffix:
Gender:F
Credentials:ACLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079A NORTH MERIDIAN RD. #208
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-396-4915
Mailing Address - Fax:
Practice Address - Street 1:9549 US ROUTE 2
Practice Address - Street 2:
Practice Address - City:MARTIN CITY
Practice Address - State:MT
Practice Address - Zip Code:59926
Practice Address - Country:US
Practice Address - Phone:406-607-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-72399101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)