Individual
DOUG J LISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.H.D.
Contact information
Practice address
1551 PACIFIC AVE, SANTA ROSA, CA 95404-3568
(707) 586-5555
(707) 303-4377
Mailing address
1551 PACIFIC AVE, SANTA ROSA, CA 95404-3568
(707) 586-5555
(707) 303-4377
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY15448
CA
Other
Enumeration date
11/10/2006
Last updated
05/01/2008
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