Healthcare Provider Details

I. General information

NPI: 1316783087
Provider Name (Legal Business Name): IRIS INNOVATIONAL COUNSELING , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11024 LEGACY DR APT 204
PALM BEACH GARDENS FL
33410-3631
US

IV. Provider business mailing address

11024 LEGACY DR APT 204
PALM BEACH GARDENS FL
33410-3631
US

V. Phone/Fax

Practice location:
  • Phone: 561-596-9015
  • Fax:
Mailing address:
  • Phone: 561-596-9015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: SCHEMILEY S SCOTT
Title or Position: CEO
Credential: LMHC
Phone: 561-596-9015