Provider Demographics
NPI:1245680057
Name:VIVIAN IRETON LLC
Entity type:Organization
Organization Name:VIVIAN IRETON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:IRETON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-449-9355
Mailing Address - Street 1:5048 S PLAZA DR
Mailing Address - Street 2:STE B
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3069
Mailing Address - Country:US
Mailing Address - Phone:812-449-9355
Mailing Address - Fax:812-607-9316
Practice Address - Street 1:5048 S PLAZA DR
Practice Address - Street 2:STE B
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3069
Practice Address - Country:US
Practice Address - Phone:812-449-9355
Practice Address - Fax:812-607-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006251A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health