Healthcare Provider Details

I. General information

NPI: 1093522047
Provider Name (Legal Business Name): CHRYSALIS HEALTH OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 SUNSET BLVD STE A
STEUBENVILLE OH
43952-1380
US

IV. Provider business mailing address

1524 SUNSET BLVD STE A
STEUBENVILLE OH
43952-1380
US

V. Phone/Fax

Practice location:
  • Phone: 800-691-6113
  • Fax: 740-264-2422
Mailing address:
  • Phone: 800-691-6113
  • Fax: 740-264-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JO-ANN PRISCO
Title or Position: VP OF CONTRACTS
Credential:
Phone: 772-216-3031