Healthcare Provider Details

I. General information

NPI: 1003515396
Provider Name (Legal Business Name): IRIS COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5838 HIGHWAY 89 S
CABOT AR
72023-8591
US

IV. Provider business mailing address

5838 HIGHWAY 89 S
CABOT AR
72023-8591
US

V. Phone/Fax

Practice location:
  • Phone: 501-351-6068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DAVIS
Title or Position: MEMBER
Credential: LPC
Phone: 501-351-6068