Provider Demographics
NPI:1386388767
Name:IRENIC THERAPEUTIC SERVICES, LLC.
Entity type:Organization
Organization Name:IRENIC THERAPEUTIC SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-875-1373
Mailing Address - Street 1:4747 E ELLIOT ROAD
Mailing Address - Street 2:UNIT 29 #703
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1629
Mailing Address - Country:US
Mailing Address - Phone:877-207-1144
Mailing Address - Fax:
Practice Address - Street 1:4539 N 22ND ST.
Practice Address - Street 2:#4501
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:877-207-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty