=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851010706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRON PSYCHOLOGY AND CONSULTING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2022
-----------------------------------------------------
Last Update Date | 08/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 TERRITORIAL RD
-----------------------------------------------------
City | BENTON HARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49022-3433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-262-5432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8467 PUCKER ST
-----------------------------------------------------
City | BERRIEN CENTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49102-9718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-262-5432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. EMILY S BURRIS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 269-262-5432
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------