=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952053803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRIS G SANTOS COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2022
-----------------------------------------------------
Last Update Date | 12/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6249 EDGEWATER DR # 1058
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32810-4739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-438-5826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6249 EDGEWATER DR # 1058
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32810-4739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 689-231-1235
-----------------------------------------------------
Fax | 877-388-0384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. IRIS GRISELDA SANTOS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 689-231-1235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------