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General NPI Number Information
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NPI Number | 1437633542
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Entity Type | Organization
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Legal Business Name | CHRYSALIS COUNSELING AND CONSULTING, INC
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 1525 E 53RD ST STE 623
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City | CHICAGO
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State | IL
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Zip | 60615-4530
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Country | US
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Telephone | 708-699-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 6958 S KING DR
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City | CHICAGO
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State | IL
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Zip | 60637-4614
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Country | US
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Telephone | 708-699-1600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | JASON E MONTGOMERY
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Credential | LCSW
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Telephone | 708-699-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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