MEDICARE: MS. IRIS ROSE MICHELLE HARRELL EDS, NCC, LPC

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	101YP2500X	Professional Counselor	LPC-20437	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC-20437	OTHER	AZ	AZ- LPC LICENSE

General Provider Information

NPI Number	:	1881187482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRIS ROSE MICHELLE HARRELL EDS, NCC, LPC

Provider Business Mailing Address
First Line	:	23380 N 61ST DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5748
Country	:	US
Telephone Number	:	602-358-7073
Fax Number	:	888-927-0409

Provider Business Practice Location Address
First Line	:	14040 N CAVE CREEK RD STE 104
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-6117
Country	:	US
Telephone Number	:	602-358-7073
Fax Number	:	888-927-0409

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

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	05/17/2025

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