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General NPI Number Information
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NPI Number | 1780975375
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Entity Type | Organization
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Legal Business Name | CHRYSALIS HEALTH SERVICES P.C.
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 3033 N WALNUT AVE WEST BUILDING, 2ND FLOOR (MIRAWORX)
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-2832
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Country | US
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Telephone | 405-230-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 3033 NORTH WALNUT
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105
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Country | US
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Telephone | 405-230-1183
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | MR. DAVID NICKELL
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Credential | L.C.S.W.
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Telephone | 405-230-1183
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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 | 3950
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License Number State | OK
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