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General NPI Number Information
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NPI Number | 1366379208
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Entity Type | Organization
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Legal Business Name | IRIDESCENCE WELLNESS STUDIO LLC
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 5118 POCONO DR
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-6017
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Country | US
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Telephone | 937-626-4807
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Fax |
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Provider Business Mailing Address
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Address Line | 5118 POCONO DR
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-6017
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Country | US
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Telephone | 937-626-4807
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Fax |
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Authorized Official
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Title or Position | OWNER/ SENIOR CLINICIAN
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Name | HELENA Q. GRAHAM
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Credential | LPCC, LICDC
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Telephone | 937-626-4807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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