Provider Demographics
NPI:1184443798
Name:KISH, IRIS (MA, NCC, LAPC)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:KISH
Suffix:
Gender:F
Credentials:MA, NCC, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 WESTGATE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7475
Mailing Address - Country:US
Mailing Address - Phone:484-891-1334
Mailing Address - Fax:
Practice Address - Street 1:2045 WESTGATE DR STE 206
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7475
Practice Address - Country:US
Practice Address - Phone:484-891-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health