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General NPI Number Information
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NPI Number | 1508395518
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Entity Type | Organization
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Legal Business Name | CHRYSALIS ENTERPRISES
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11930 MENAUL BLVD NE STE 225C
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2465
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Country | US
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Telephone | 505-323-4447
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Fax | 505-323-5075
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Provider Business Mailing Address
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Address Line | 11930 MENAUL BLVD NE SUITE #225C
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City | ALBUQUERQUE
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State | NM
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Zip | 87048
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Country | US
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Telephone | 505-323-4447
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Fax | 505-323-5075
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Authorized Official
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Title or Position | MEMBER
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Name | JULIE A WATSON
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Credential | LPCC
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Telephone | 505-323-4447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 005683
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License Number State | NM
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