Provider Demographics
NPI:1952053803
Name:IRIS G SANTOS COUNSELING LLC
Entity Type:Organization
Organization Name:IRIS G SANTOS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:GRISELDA
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:689-231-1235
Mailing Address - Street 1:6249 EDGEWATER DR # 1058
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4739
Mailing Address - Country:US
Mailing Address - Phone:689-231-1235
Mailing Address - Fax:877-388-0384
Practice Address - Street 1:6249 EDGEWATER DR # 1058
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4739
Practice Address - Country:US
Practice Address - Phone:321-438-5826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111169900Medicaid