MEDICARE: IRIS BILAN

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	79566	TX

General Provider Information

NPI Number	:	1639668940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS BILAN

Provider Business Mailing Address
First Line	:	9002 PITNER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-1745
Country	:	US
Telephone Number	:	713-359-6468
Fax Number	:

Provider Business Practice Location Address
First Line	:	9112 SPRING BRANCH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-7454
Country	:	US
Telephone Number	:	133-596-4687
Fax Number	:

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

Provider Enumeration Date	:	05/02/2018
Last Update Date	:	05/02/2018

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Directions to “ IRIS BILAN ” Practice Location

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