Provider Demographics
NPI:1568958817
Name:JENNIFER BRADLEY OR CHRYSALIS THERAPY
Entity Type:Organization
Organization Name:JENNIFER BRADLEY OR CHRYSALIS THERAPY
Other - Org Name:CHRYSALIS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:205-677-8134
Mailing Address - Street 1:16700 HIGHWAY 280 STE 222
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-8325
Mailing Address - Country:US
Mailing Address - Phone:205-677-8134
Mailing Address - Fax:
Practice Address - Street 1:2039 FAIRBANK CIR
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-7235
Practice Address - Country:US
Practice Address - Phone:205-677-8134
Practice Address - Fax:844-579-0080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIFER BRADLEY OR CHRYSALIS THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
AL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty