Provider Demographics
NPI:1598162919
Name:CARLISLE, JEFFREY (LPC-I)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 PEPPER MILL DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-4657
Mailing Address - Country:US
Mailing Address - Phone:361-331-5302
Mailing Address - Fax:
Practice Address - Street 1:2727 MORGAN AVE
Practice Address - Street 2:200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1821
Practice Address - Country:US
Practice Address - Phone:361-980-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71462101YP2500X
TX99401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional