Provider Demographics
NPI:1356937254
Name:CHRYSALIS COUNSELING COACHING AND CONSULTING LLC
Entity type:Organization
Organization Name:CHRYSALIS COUNSELING COACHING AND CONSULTING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SAMEKA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOWELL MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:219-286-2764
Mailing Address - Street 1:18125 ROY ST UNIT 622
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1918 GARLAND CIRCLE DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-1161
Practice Address - Country:US
Practice Address - Phone:773-345-7529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty