Provider Demographics
NPI:1508638024
Name:CARLISLE, JULIE ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 S 100 E STE 300
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2253
Mailing Address - Country:US
Mailing Address - Phone:801-333-0246
Mailing Address - Fax:801-383-0246
Practice Address - Street 1:95 S 100 E
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2252
Practice Address - Country:US
Practice Address - Phone:801-382-9338
Practice Address - Fax:801-383-0246
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8642853-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health