Provider Demographics
NPI:1659078186
Name:CHRYSALIS COUNSELING GROUP PLLC
Entity Type:Organization
Organization Name:CHRYSALIS COUNSELING GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROCKWELL
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-679-7928
Mailing Address - Street 1:727 MONTICELLO PL
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1745
Mailing Address - Country:US
Mailing Address - Phone:773-679-7928
Mailing Address - Fax:
Practice Address - Street 1:3257 N SHEFFIELD AVE STE 108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2276
Practice Address - Country:US
Practice Address - Phone:773-679-7928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty