Provider Demographics
NPI:1922236629
Name:CHRYSALIS CENTER FOR FAMILY GROWTH, LLC
Entity Type:Organization
Organization Name:CHRYSALIS CENTER FOR FAMILY GROWTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:970-223-2054
Mailing Address - Street 1:109 CAMERON DR BLDG A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3961
Mailing Address - Country:US
Mailing Address - Phone:970-223-2054
Mailing Address - Fax:970-223-5074
Practice Address - Street 1:109 CAMERON DR BLDG A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3961
Practice Address - Country:US
Practice Address - Phone:970-223-2054
Practice Address - Fax:970-223-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5217251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5217OtherLICENSE NUMBER