Healthcare Provider Details

I. General information

NPI: 1104539030
Provider Name (Legal Business Name): CHRYSALIS THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 HOLLY WAY
WEST RICHLAND WA
99353-5716
US

IV. Provider business mailing address

4820 HOLLY WAY
WEST RICHLAND WA
99353-5716
US

V. Phone/Fax

Practice location:
  • Phone: 509-362-9411
  • Fax:
Mailing address:
  • Phone: 509-362-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR BLACKWELL
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: LMFT
Phone: 509-362-9411