Katrena Dezerai Palmer, LAC

Key facts

NPI

1710795463

Entity type

Individual (NPI type 1)

Primary specialty

Addiction (Substance Use Disorder) Counselor 101YA0400X

Practice address

130 3Rd St S
Glasgow, MT 59230-2303

Phone

(406) 228-9349

NPI assigned

Dec 27, 2024

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eastern Montana Community Mental Health Center Clinic/Center · Miles City, MT · NPI 1992786784
  NPD (past) ADDICTION (SUBSTANCE USE DISORDER)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 27, 2024.

{
    "created_epoch": "1735257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1710795463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1530",
            "city": "MILES CITY",
            "state": "MT",
            "postal_code": "593011530",
            "telephone_number": "406-234-0234",
            "fax_number": "406-234-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 3RD ST S",
            "city": "GLASGOW",
            "state": "MT",
            "postal_code": "592302303",
            "telephone_number": "406-228-9349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMER",
        "first_name": "KATRENA",
        "middle_name": "DEZERAI",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-27",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAC LICENSE",
            "identifier": "71830",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Glasgow, MT · Addiction (Substance Use Disorder) Counselor in Montana