Active NPI
Paul Carlisle Jr., ED.D.
- Professional Counselor
- Independence, MO
National Provider Identifier
1477793636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2008007213
- Practice address
- 3031 Frontage Road
Suite 200
Independence, MO 64057 - Phone
- (816) 373-9240
- NPI assigned
- Mar 2, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2008007213 | MO | Primary |
Addresses
Primary practice location
3031 Frontage Road
Suite 200
Independence, MO 64057
Mailing address
3031 Frontage Rd.
Suite 200
Independence, MO 64057
Phone (816) 373-9240
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2008007213 | MO | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diakonos Inc | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235952000000",
"number": "1477793636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3031 FRONTAGE RD.",
"address_2": "SUITE 200",
"city": "INDEPENDENCE",
"state": "MO",
"postal_code": "64057",
"telephone_number": "816-373-9240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3031 FRONTAGE ROAD",
"address_2": "SUITE 200",
"city": "INDEPENDENCE",
"state": "MO",
"postal_code": "64057",
"telephone_number": "816-373-9240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLISLE",
"first_name": "PAUL",
"name_suffix": "Jr.",
"credential": "ED.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-02",
"last_updated": "2009-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2008007213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Independence, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.