Provider Demographics
NPI:1255510707
Name:CARLISLE, WAYLON A (PHD)
Entity type:Individual
Prefix:DR
First Name:WAYLON
Middle Name:A
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:WAYLON
Other - Middle Name:A
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:13309 WALDEN SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-5547
Mailing Address - Country:US
Mailing Address - Phone:813-684-3397
Mailing Address - Fax:
Practice Address - Street 1:2302 BELL SHOALS RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-684-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCPY0013010194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health