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Contact Information

DOUG J LISLE, P.H.D.
1551 PACIFIC AVE
SANTA ROSA, CA95404-3568
 Phone: 707-586-5555
 Fax: 707-303-4377
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for DOUG J LISLE · (Male)

NPI # 1831260009
Status Active
Credentials P.H.D.
Entity Individual
Enumeration date 11/10/2006
Last updated 05/01/2008 - About 18 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # PSY15448
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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