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General NPI Number Information
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NPI Number | 1871471102
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Entity Type | Individual
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Provider Name | IRIS ELISE WELLCOME PPS CREDENTIAL
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Gender | Female
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 5044 JONES ST
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City | MARIPOSA
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State | CA
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Zip | 95338-2424
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Country | US
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Telephone | 97-420-3402
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5002
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City | MARIPOSA
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State | CA
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Zip | 95338-5002
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Country | US
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Telephone | 209-742-0340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 250197555
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License Number State | CA
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