Provider Demographics
NPI:1487714747
Name:NAVIDOMSKIS, CARLISLE (LPC)
Entity type:Individual
Prefix:
First Name:CARLISLE
Middle Name:
Last Name:NAVIDOMSKIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14200 ASHFORD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6407
Mailing Address - Country:US
Mailing Address - Phone:915-852-0011
Mailing Address - Fax:915-852-0011
Practice Address - Street 1:14200 ASHFORD ST
Practice Address - Street 2:SUITE A
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-6407
Practice Address - Country:US
Practice Address - Phone:915-852-0011
Practice Address - Fax:915-852-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6153LCOtherBLUE CROSS BLUE SHIELD