Provider Demographics
NPI:1740026582
Name:IRIS COUNSELING AND THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:IRIS COUNSELING AND THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:205-299-4084
Mailing Address - Street 1:2127 VESTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2923
Mailing Address - Country:US
Mailing Address - Phone:205-299-4084
Mailing Address - Fax:
Practice Address - Street 1:2127 VESTRIDGE CT
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-2923
Practice Address - Country:US
Practice Address - Phone:205-299-4084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)