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General NPI Number Information
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NPI Number | 1144734922
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Entity Type | Organization
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Legal Business Name | IRIS HEALING CENTER LLC
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 07/02/2022
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Provider Practice Location Address
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Address Line | 20300 VENTURA BLVD STE 300
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-0901
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Country | US
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Telephone | 323-449-0016
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Fax | 323-449-0016
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Provider Business Mailing Address
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Address Line | 20300 VENTURA BLVD STE 300
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-0901
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Country | US
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Telephone | 323-449-0016
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Fax | 818-301-1940
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Authorized Official
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Title or Position | CEO
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Name | DR. ELENA KAPUSTINA
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Credential | PSYD
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Telephone | 323-449-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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