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General NPI Number Information
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NPI Number | 1609489822
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Entity Type | Organization
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Legal Business Name | CHRYSALIS COUNSELING OF MONTANA
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Dates
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Enumeration Date | 08/27/2020
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 1119 W KENT AVE STE F
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City | MISSOULA
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State | MT
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Zip | 59801-6687
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Country | US
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Telephone | 406-214-2459
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 755
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City | MISSOULA
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State | MT
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Zip | 59806-0755
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Country | US
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Telephone | 406-214-2459
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HANNAH EILEEN KIRBY-ZIMMERMAN
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Credential | LCPC
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Telephone | 406-214-2459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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