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General NPI Number Information
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NPI Number | 1164218715
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Entity Type | Organization
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Legal Business Name | CARLISLE ART THERAPY PLLC
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 1918 N MENDELL ST STE 200
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City | CHICAGO
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State | IL
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Zip | 60642-1282
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Country | US
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Telephone | 815-545-1530
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Fax |
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Provider Business Mailing Address
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Address Line | 2043 W BELMONT AVE APT 4
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City | CHICAGO
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State | IL
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Zip | 60618-6796
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, ART THERAPIST, COUNSELOR
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Name | JESSICA CARLISLE
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Credential | LCPC, ATR-BC
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Telephone | 815-545-1530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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