Provider Demographics
NPI:1558007013
Name:CHRYSALIS PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:CHRYSALIS PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:737-287-1255
Mailing Address - Street 1:301 S HEATHERWILDE BLVD UNIT 2602
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78691-4006
Mailing Address - Country:US
Mailing Address - Phone:737-287-1255
Mailing Address - Fax:
Practice Address - Street 1:1100 SWEET LEAF LN
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-7943
Practice Address - Country:US
Practice Address - Phone:737-287-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health