Healthcare Provider Details

I. General information

NPI: 1710823570
Provider Name (Legal Business Name): CHRYSALIS GROWTH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 NW STONECREST CT
BLUE SPRINGS MO
64015-1770
US

IV. Provider business mailing address

2609 NW STONECREST CT
BLUE SPRINGS MO
64015-1770
US

V. Phone/Fax

Practice location:
  • Phone: 816-510-4196
  • Fax:
Mailing address:
  • Phone: 816-510-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD CLEMENTE BAMBENEK
Title or Position: PROFESSIONAL COUNSELOR
Credential: LLC
Phone: 816-510-4196