Provider Demographics
NPI:1396334041
Name:CARLISLE, JENNIFER-CRYSTAL
Entity type:Individual
Prefix:
First Name:JENNIFER-CRYSTAL
Middle Name:
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 TACOMA AVE S UNIT 1
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-6849
Mailing Address - Country:US
Mailing Address - Phone:253-389-1018
Mailing Address - Fax:
Practice Address - Street 1:915 26TH ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-2502
Practice Address - Country:US
Practice Address - Phone:253-389-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health