MEDICARE: DORIS IRVIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2014041249	MO

General Provider Information

NPI Number	:	1184168668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS IRVIN

Provider Business Mailing Address
First Line	:	3037 LEXINGTON AVE
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-2602
Country	:	US
Telephone Number	:	573-382-7220
Fax Number	:

Provider Business Practice Location Address
First Line	:	3037 LEXINGTON AVE
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-2602
Country	:	US
Telephone Number	:	573-382-7220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	01/16/2026

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Directions to “ DORIS IRVIN ” Practice Location

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