Healthcare Provider Details

I. General information

NPI: 1609787936
Provider Name (Legal Business Name): IRIS COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 KEATON CROSSING BLVD STE 106B
O FALLON MO
63368-8218
US

IV. Provider business mailing address

7701 BOARDWALK TOWER CIR
O FALLON MO
63368-4169
US

V. Phone/Fax

Practice location:
  • Phone: 865-604-3630
  • Fax:
Mailing address:
  • Phone: 865-604-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATELYN WALKER
Title or Position: OWNER
Credential: LPC
Phone: 865-604-3630