Healthcare Provider Details

I. General information

NPI: 1609489822
Provider Name (Legal Business Name): CHRYSALIS COUNSELING OF MONTANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 W KENT AVE STE F
MISSOULA MT
59801-6687
US

IV. Provider business mailing address

PO BOX 755
MISSOULA MT
59806-0755
US

V. Phone/Fax

Practice location:
  • Phone: 406-214-2459
  • Fax:
Mailing address:
  • Phone: 406-214-2459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HANNAH EILEEN KIRBY-ZIMMERMAN
Title or Position: OWNER
Credential: LCPC
Phone: 406-214-2459