Provider Demographics
NPI:1477722726
Name:ISALES, CARMELO JR (PSYD LMFT)
Entity Type:Individual
Prefix:DR
First Name:CARMELO
Middle Name:
Last Name:ISALES
Suffix:JR
Gender:M
Credentials:PSYD LMFT
Other - Prefix:MR
Other - First Name:CARMELO
Other - Middle Name:
Other - Last Name:ISALES
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:29384 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5855
Mailing Address - Country:US
Mailing Address - Phone:951-970-7935
Mailing Address - Fax:877-755-4903
Practice Address - Street 1:29970 TECHNOLOGY DR STE 105B
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2646
Practice Address - Country:US
Practice Address - Phone:951-970-7935
Practice Address - Fax:877-755-4903
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist