Provider Demographics
NPI:1457567455
Name:CARLISLE, MELINDA JANE (LMFT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:JANE
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 MARCIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-4761
Mailing Address - Country:US
Mailing Address - Phone:408-893-4032
Mailing Address - Fax:408-448-1828
Practice Address - Street 1:3880 S BASCOM AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2674
Practice Address - Country:US
Practice Address - Phone:408-893-4032
Practice Address - Fax:408-448-1828
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43877106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist