Provider Demographics
NPI:1578270930
Name:CRYSALIS COUNSELING & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:CRYSALIS COUNSELING & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APPROVED CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:MCINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC NBCC
Authorized Official - Phone:360-357-7446
Mailing Address - Street 1:1801 W BAY DR NW STE 208A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4314
Mailing Address - Country:US
Mailing Address - Phone:360-357-7446
Mailing Address - Fax:360-252-7320
Practice Address - Street 1:1801 W BAY DR NW STE 208A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4314
Practice Address - Country:US
Practice Address - Phone:360-357-7446
Practice Address - Fax:360-252-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty