Provider Demographics
NPI:1609369776
Name:IRISE SUPPORT SERVICES
Entity Type:Organization
Organization Name:IRISE SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-MHSP
Authorized Official - Phone:615-631-7489
Mailing Address - Street 1:805 S CHURCH ST STE 15
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4917
Mailing Address - Country:US
Mailing Address - Phone:615-410-7294
Mailing Address - Fax:615-410-7074
Practice Address - Street 1:805 S CHURCH ST STE 15
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4917
Practice Address - Country:US
Practice Address - Phone:615-631-7489
Practice Address - Fax:615-494-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty