MEDICARE: IRIS INNOVATIONAL COUNSELING , LLC

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	104100000X	Social Worker
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1316783087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRIS INNOVATIONAL COUNSELING , LLC

Provider Business Mailing Address
First Line	:	11024 LEGACY DR APT 204
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3631
Country	:	US
Telephone Number	:	561-596-9015
Fax Number	:

Provider Business Practice Location Address
First Line	:	11024 LEGACY DR APT 204
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3631
Country	:	US
Telephone Number	:	561-596-9015
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SCHEMILEY S SCOTT
Credential	:	LMHC
Telephone Number	:	561-596-9015

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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