Provider Demographics
NPI:1578314209
Name:KHRYSALIS PSYCHOTROPICS PC
Entity Type:Organization
Organization Name:KHRYSALIS PSYCHOTROPICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-979-9435
Mailing Address - Street 1:4225 NIBLICK DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8326
Mailing Address - Country:US
Mailing Address - Phone:661-979-9435
Mailing Address - Fax:
Practice Address - Street 1:413 SUMMIT BLVD UNIT 204
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8295
Practice Address - Country:US
Practice Address - Phone:303-284-9802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty