| Palmtree Psychological Services, Llc | |
|
111 Woodrow Wilson Dr Suite B Valdosta GA 31602-2587 | |
| (229) 219-1811 | |
| (229) 219-8472 |
| Full Name | Palmtree Psychological Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 111 Woodrow Wilson Dr, Valdosta, Georgia |
| Authorized Official Name and Position | Valentina Benjamin (OFFICE MANAGER) |
| Authorized Official Contact | 2292191811 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Palmtree Psychological Services, Llc 111 Woodrow Wilson Dr Suite B Valdosta GA 31602-2587 Ph: (229) 219-1811 | Palmtree Psychological Services, Llc 111 Woodrow Wilson Dr Suite B Valdosta GA 31602-2587 Ph: (229) 219-1811 |
| NPI Number | 1750632279 |
|---|---|
| Provider Enumeration Date | 09/24/2012 |
| Last Update Date | 09/24/2012 |
| Medicare PECOS PAC ID | 4284984493 |
|---|---|
| Medicare Enrollment ID | O20180910002664 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750632279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY001796 (Georgia) | Primary |
| Provider Name | Wilhelmenia Howell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386670115 PECOS PAC ID: 6002867504 Enrollment ID: I20050202000149 |
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