Provider Demographics
NPI:1053528505
Name:PALM, MELODY DARLENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:DARLENE
Last Name:PALM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 E CHERRY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-3429
Mailing Address - Country:US
Mailing Address - Phone:417-818-4187
Mailing Address - Fax:417-863-7039
Practice Address - Street 1:1330 E CHERRY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3429
Practice Address - Country:US
Practice Address - Phone:417-818-4187
Practice Address - Fax:417-863-7039
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004005777103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical