| Chrysalis Utah, Inc. | |
|
1507 S 180 E Provo UT 84606-5570 | |
| (801) 426-6661 | |
| Not Available |
| Full Name | Chrysalis Utah, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1507 S 180 E, Provo, Utah |
| Authorized Official Name and Position | Richard Slack (CFO) |
| Authorized Official Contact | 8016554950 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chrysalis Utah, Inc. 1443 W 800 N Ste 103 Orem UT 84057-2878 Ph: () - | Chrysalis Utah, Inc. 1507 S 180 E Provo UT 84606-5570 Ph: (801) 426-6661 |
| NPI Number | 1356843114 |
|---|---|
| Provider Enumeration Date | 03/07/2018 |
| Last Update Date | 03/07/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356843114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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