Individual ProviderDerricketa PalacioCounselorBehavioral Health & Social Service ProvidersPractice Address5715 S Broadway, Los Angeles, CA 90037-4131(323) 948-0444PECOS EnrollmentBased on the most recent information from CMS, provider Derricketa Palacio does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1043853039Provider TypeIndividualFull NamePalacio, DerricketaGenderFemaleSole ProprietorYesEnumeration Date10/22/2019Last Updated3/17/2023Contact InformationPractice LocationPractice Address5715 S Broadway, Los Angeles, CA 90037-4131Phone(323) 948-0444FaxUnlisted FaxMailing LocationMailing Address5715 S Broadway, Los Angeles, CA 90037-4131Phone(323) 948-0444FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YA0400XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCaliforniaCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer