Provider Demographics
NPI:1427377290
Name:CARLISLE, NICOLE M (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 RENE ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4052
Mailing Address - Country:US
Mailing Address - Phone:913-825-0893
Mailing Address - Fax:913-825-0896
Practice Address - Street 1:10621 RENE ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4052
Practice Address - Country:US
Practice Address - Phone:913-825-0893
Practice Address - Fax:913-825-0896
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst