# CAROL LIESER PMHNP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** In His Image Psychiatry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972043669
- **Authorized official:** CAROL LIESER PHD APRN PMHNP BC (OWNER/PSYCH MENTAL HEALTH NURSE PRA)
- **Authorized official phone:** (817) 914-4168

## Contact information

- **Practice address:** 4425 W AIRPORT FWY, STE 244, IRVING, TX 75062
- **Practice address phone:** (972) 252-2945
- **Practice address fax:** (888) 975-2092
- **Mailing address:** 4425 W AIRPORT FWY, STE 244, IRVING, TX 75062
- **Mailing address phone:** (972) 252-2945
- **Mailing address fax:** (888) 975-2092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 462622/AP108300 | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 462622/AP108300 | — | Yes |

## Other

- **Enumeration date:** 03/01/2017
- **Last updated:** 03/01/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | NP7659 | BC/BS | TX |