Healthcare Provider Details

I. General information

NPI: 1760872956
Provider Name (Legal Business Name): DAVID BRICE CARLISLE LPC, LCDC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10039 BISSONNET ST STE 105
HOUSTON TX
77036-7838
US

IV. Provider business mailing address

10039 BISSONNET ST STE 105
HOUSTON TX
77036-7838
US

V. Phone/Fax

Practice location:
  • Phone: 832-831-3651
  • Fax: 832-831-3652
Mailing address:
  • Phone: 832-831-3651
  • Fax: 832-831-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number69965
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: