Provider Demographics
NPI:1063832897
Name:CARLISLE, MURIELL (MS)
Entity Type:Individual
Prefix:
First Name:MURIELL
Middle Name:
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 PRUNER RD
Mailing Address - Street 2:
Mailing Address - City:RIDDLE
Mailing Address - State:OR
Mailing Address - Zip Code:97469-8639
Mailing Address - Country:US
Mailing Address - Phone:541-671-9748
Mailing Address - Fax:
Practice Address - Street 1:PINKSTON DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7362
Practice Address - Country:US
Practice Address - Phone:541-671-9748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-20
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12126101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health