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
—
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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