MEDICARE: CARLISLE ART THERAPY PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164218715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLISLE ART THERAPY PLLC

Provider Business Mailing Address
First Line	:	2043 W BELMONT AVE APT 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6796
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1918 N MENDELL ST STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-1282
Country	:	US
Telephone Number	:	815-545-1530
Fax Number	:

Authorized Official
Title or Position	:	OWNER, ART THERAPIST, COUNSELOR
Name	:	JESSICA CARLISLE
Credential	:	LCPC, ATR-BC
Telephone Number	:	815-545-1530

Provider Enumeration Date	:	04/18/2025
Last Update Date	:	04/18/2025

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