Provider Demographics
NPI:1730114018
Name:HAZE, IRIS LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:LYNN
Last Name:HAZE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 HIGHWAY 6 N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-1304
Mailing Address - Country:US
Mailing Address - Phone:281-345-9429
Mailing Address - Fax:
Practice Address - Street 1:7011 SW FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2007
Practice Address - Country:US
Practice Address - Phone:713-222-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145042106Medicaid
TX145042104Medicaid
TX145042105Medicaid
TX87253QOtherBLUE CROSS BLUE SHIELD
TX145042111Medicaid
TX145042103Medicaid
TX87253QOtherBLUE CROSS BLUE SHIELD
TX145042111Medicaid
TX145042104Medicaid
TX8C9006Medicare ID - Type UnspecifiedMCR 00622R
TX8D3137Medicare ID - Type UnspecifiedMCR BRAZ. CTY.
TX8J9934Medicare PIN
TX145042103Medicaid
TX8D3129Medicare ID - Type UnspecifiedMCR HARRI CTY.
TX145042105Medicaid