Provider Demographics
NPI:1508395518
Name:CHRYSALIS ENTERPRISES
Entity Type:Organization
Organization Name:CHRYSALIS ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-323-4447
Mailing Address - Street 1:11930 MENAUL BLVD NE
Mailing Address - Street 2:SUITE #225C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87048
Mailing Address - Country:US
Mailing Address - Phone:505-323-4447
Mailing Address - Fax:505-323-5075
Practice Address - Street 1:11930 MENAUL BLVD NE STE 225C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2465
Practice Address - Country:US
Practice Address - Phone:505-323-4447
Practice Address - Fax:505-323-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005683261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health