Healthcare Provider Details

I. General information

NPI: 1023528213
Provider Name (Legal Business Name): IRIS MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14665 GALAXIE AVE STE 140
APPLE VALLEY MN
55124-4509
US

IV. Provider business mailing address

14665 GALAXIE AVE STE 140
APPLE VALLEY MN
55124-4509
US

V. Phone/Fax

Practice location:
  • Phone: 651-456-8494
  • Fax:
Mailing address:
  • Phone: 651-456-8494
  • Fax: 952-686-6966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL CLANCY
Title or Position: PRESIDENT
Credential: LMFT PMH-C
Phone: 651-456-8494