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NPI Code Detail

MEDICARE: IRIS MENTAL HEALTH, LLC

MEDICARE: IRIS MENTAL HEALTH, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023528213
Entity Type Code : Organization
Provider Name (Legal Business Name) : IRIS MENTAL HEALTH, LLC
Provider Business Mailing Address
First Line : 14665 GALAXIE AVE STE 140
Second Line :
City : APPLE VALLEY
State : MN
Zip : 55124-4509
Country : US
Telephone Number : 651-456-8494
Fax Number : 952-686-6966
Provider Business Practice Location Address
First Line : 14665 GALAXIE AVE STE 140
Second Line :
City : APPLE VALLEY
State : MN
Zip : 55124-4509
Country : US
Telephone Number : 651-456-8494
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CRYSTAL CLANCY
Credential : LMFT PMH-C
Telephone Number : 651-456-8494
Provider Enumeration Date : 10/03/2017
Last Update Date : 04/22/2026

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Directions to “IRIS MENTAL HEALTH, LLC ” Practice Location

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