Provider Demographics
NPI:1003281130
Name:IRISE COUNSELING SERVICES
Entity type:Organization
Organization Name:IRISE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPCS
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURICE
Authorized Official - Middle Name:DEROZAN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DPC, LPC-S
Authorized Official - Phone:225-647-9001
Mailing Address - Street 1:214 S BURNSIDE AVE.
Mailing Address - Street 2:203
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737
Mailing Address - Country:US
Mailing Address - Phone:225-647-9001
Mailing Address - Fax:225-647-9001
Practice Address - Street 1:214 S BURNSIDE AVE.
Practice Address - Street 2:203
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-647-9001
Practice Address - Fax:225-647-9001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRISE COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-01
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health