Provider Demographics
NPI:1871471102
Name:WELLCOME, IRIS ELISE (PPS CREDENTIAL)
Entity type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:ELISE
Last Name:WELLCOME
Suffix:
Gender:F
Credentials:PPS CREDENTIAL
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:ELISE
Other - Last Name:HEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TEACHING CREDENTIAL
Mailing Address - Street 1:PO BOX 5002
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-5002
Mailing Address - Country:US
Mailing Address - Phone:209-742-0340
Mailing Address - Fax:
Practice Address - Street 1:5044 JONES ST
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-2424
Practice Address - Country:US
Practice Address - Phone:097-420-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250197555101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor