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General NPI Number Information
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NPI Number | 1659078186
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Entity Type | Organization
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Legal Business Name | CHRYSALIS COUNSELING GROUP PLLC
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 3257 N SHEFFIELD AVE STE 108
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City | CHICAGO
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State | IL
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Zip | 60657-2276
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Country | US
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Telephone | 773-679-7928
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Fax |
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Provider Business Mailing Address
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Address Line | 727 MONTICELLO PL
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City | EVANSTON
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State | IL
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Zip | 60201-1745
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Country | US
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Telephone | 773-679-7928
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MR. CHARLES ROCKWELL BURT
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Credential | LCPC
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Telephone | 773-679-7928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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