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General NPI Number Information
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NPI Number | 1952130643
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Entity Type | Organization
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Legal Business Name | BLUE CHRYSALIS COUNSELING LLC
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Dates
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Enumeration Date | 07/30/2024
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 1435 VINE ST STE 509
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City | CINCINNATI
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State | OH
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Zip | 45202-7094
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Country | US
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Telephone | 513-327-8878
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Fax |
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Provider Business Mailing Address
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Address Line | 325 PARKTRACE CT
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City | CINCINNATI
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State | OH
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Zip | 45238-6296
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Country | US
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Telephone | 513-218-2828
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LARA SHADOWENS
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Credential | MSW, LISW
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Telephone | 513-218-2828
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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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