Healthcare Provider Details

I. General information

NPI: 1609369776
Provider Name (Legal Business Name): IRISE SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S CHURCH ST STE 15
MURFREESBORO TN
37130-4917
US

IV. Provider business mailing address

805 S CHURCH ST STE 15
MURFREESBORO TN
37130-4917
US

V. Phone/Fax

Practice location:
  • Phone: 615-631-7489
  • Fax: 615-494-1145
Mailing address:
  • Phone: 615-410-7294
  • Fax: 615-410-7074

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHATONYA CRAYTON
Title or Position: CO-CEO
Credential: M.S., LPC-MHSP
Phone: 615-631-7489