Provider Demographics
NPI:1801122320
Name:CHRYSALIS FAMILY COUNSELING CENTER
Entity type:Organization
Organization Name:CHRYSALIS FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GEN. PARTNER/BUSINESS & FINANCE MGR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-782-9616
Mailing Address - Street 1:4145 9TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3101
Mailing Address - Country:US
Mailing Address - Phone:951-782-9616
Mailing Address - Fax:951-782-9637
Practice Address - Street 1:4145 9TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3101
Practice Address - Country:US
Practice Address - Phone:951-782-9616
Practice Address - Fax:951-782-9637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty