Provider Demographics
NPI:1689192452
Name:PALM, NOELLE (MA, LMFT, ATR-P)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:PALM
Suffix:
Gender:F
Credentials:MA, LMFT, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6889 YEAGER PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-3139
Mailing Address - Country:US
Mailing Address - Phone:917-301-4459
Mailing Address - Fax:
Practice Address - Street 1:6889 YEAGER PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-3139
Practice Address - Country:US
Practice Address - Phone:917-301-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA131585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program