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Organization
CAROL LIESER PMHNP PLLC
Active
Organization
CAROL LIESER PMHNP PLLC
Active
Other names
In His Image Psychiatry
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL LIESER PHD APRN PMHNP BC (OWNER/PSYCH MENTAL HEALTH NURSE PRA)
(817) 914-4168
Entity
Organization
Contact information
Practice address
4425 W AIRPORT FWY, STE 244, IRVING, TX 75062
(972) 252-2945
(888) 975-2092
Mailing address
4425 W AIRPORT FWY, STE 244, IRVING, TX 75062
(972) 252-2945
(888) 975-2092
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
462622/AP108300
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
462622/AP108300
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP7659
BC/BS
TX
Enumeration date
03/01/2017
Last updated
03/01/2017
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