1972043669 NPI number — CAROL LIESER PMHNP PLLC

Table of content: (NPI 1972043669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972043669 NPI number — CAROL LIESER PMHNP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROL LIESER PMHNP PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IN HIS IMAGE PSYCHIATRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972043669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4425 W AIRPORT FWY
Provider Second Line Business Mailing Address:
STE 244
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-252-2945
Provider Business Mailing Address Fax Number:
888-975-2092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4425 W AIRPORT FWY
Provider Second Line Business Practice Location Address:
STE 244
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-252-2945
Provider Business Practice Location Address Fax Number:
888-975-2092
Provider Enumeration Date:
03/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LIESER
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PSYCH MENTAL HEALTH NURSE PRA
Authorized Official Telephone Number:
817-914-4168

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  462622/AP108300 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP7659 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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