MEDICARE: DESTINY CARLISLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1316804990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY CARLISLE

Provider Business Mailing Address
First Line	:	2759 SUNSWEPT CT
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-7603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1265 S LAKE PARK AVE STE B
Second Line	:
City	:	HOBART
State	:	IN
Zip	:	46342-5961
Country	:	US
Telephone Number	:	219-323-3311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ DESTINY CARLISLE ” Practice Location

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