Provider Demographics
NPI:1609489822
Name:CHRYSALIS COUNSELING OF MONTANA
Entity Type:Organization
Organization Name:CHRYSALIS COUNSELING OF MONTANA
Other - Org Name:HANNAH KIRBY-ZIMMERMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:KIRBY-ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-214-2459
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-0755
Mailing Address - Country:US
Mailing Address - Phone:406-214-2459
Mailing Address - Fax:
Practice Address - Street 1:1119 W KENT AVE STE F
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6687
Practice Address - Country:US
Practice Address - Phone:406-214-2459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty