| Doctor Name: | DR. MICHAEL ALAN CARLISH |
| NPI Number: | 1063771863 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PSY 24938 |
| Business Practice Address: | 50100 Golsh Rd Valley Center, CA - 920825338 |
| Business Phone Number: | 7607491410 |
| Business Fax Number: | 7607493347 |
| Mailing Address: | 1611 S Melrose Dr, Suite A # 251 VISTA |
| State: | CA |
| Postal Code: | 920815407 |
| Phone Number: | 7607491410 |
| Fax Number: | 7607493347 |
| NPI Enumeration Date: | 05/14/2012 |
| NPI Last Update Date: | 05/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY 24938 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |