Provider Demographics
NPI:1659032415
Name:HEIEREN, IRIS (MA, LAMFT)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:HEIEREN
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 WHITE BEAR PKWY STE 1500
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3697
Mailing Address - Country:US
Mailing Address - Phone:651-792-5743
Mailing Address - Fax:
Practice Address - Street 1:4505 WHITE BEAR PKWY STE 1500
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3697
Practice Address - Country:US
Practice Address - Phone:651-792-5743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health