| Organization Name: | CHARLES CARLISE EDD PSYCHOLOGIST |
| NPI Number: | 1497948707 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES GASPER CARLISE (PSYCHOLOGIST) |
| Mailing Address: | 2345 E Thomas Rd Suite 295 Phoenix |
| State: | AZ US |
| Postal Code: | 850167848 |
| Phone Number: | 6026222933 |
| Fax Number: | 6029573063 |
| NPI Enumeration Date: | 08/20/2007 |
| NPI Last Update Date: | 08/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | 3229 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |