MEDICARE: CARISALEZ PSYCHOLOGICAL SERVICES, 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1790632206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARISALEZ PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	6900 BRITTANYWOOD DR
Second Line	:
City	:	DELTON
State	:	MI
Zip	:	49046-8409
Country	:	US
Telephone Number	:	269-569-3430
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 BRITTANYWOOD DR
Second Line	:
City	:	DELTON
State	:	MI
Zip	:	49046-8409
Country	:	US
Telephone Number	:	269-569-3430
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUAN CARISALEZ
Credential	:	LLP
Telephone Number	:	269-569-3430

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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