Provider Demographics
NPI:1043254543
Name:CARLE, DEBORAH LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LYNN
Last Name:CARLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 NALL AVE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1924
Mailing Address - Country:US
Mailing Address - Phone:913-549-4390
Mailing Address - Fax:913-549-4392
Practice Address - Street 1:11111 NALL AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1924
Practice Address - Country:US
Practice Address - Phone:913-549-4390
Practice Address - Fax:913-549-4392
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01716103TC0700X
KS961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA297780Medicare ID - Type Unspecified