Provider Demographics
NPI:1497717573
Name:CHRYSALIS COUNSELING CENTER, L.L.C.
Entity Type:Organization
Organization Name:CHRYSALIS COUNSELING CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-808-9311
Mailing Address - Street 1:7321 S STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2055
Mailing Address - Country:US
Mailing Address - Phone:801-808-9311
Mailing Address - Fax:801-561-9311
Practice Address - Street 1:7321 S STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2055
Practice Address - Country:US
Practice Address - Phone:801-808-9311
Practice Address - Fax:801-561-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT130765-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========KRROtherEDUCATORS MUTUAL INSURANC