=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760376438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRIS MENTAL HEALTH & COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2025
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7220 W JEFFERSON AVE STE 216
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80235-2023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-772-8460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7220 W JEFFERSON AVE STE 216
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80235-2023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-772-8460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KELLY PICUNE
-----------------------------------------------------
Credential | MS, MA, LPCC
-----------------------------------------------------
Telephone | 720-772-8460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------