MEDICARE: CHRYSALIS COUNSELING, P. C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	2035	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790997385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRYSALIS COUNSELING, P. C.

Provider Business Mailing Address
First Line	:	3609 CEDAR SPRINGS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4905
Country	:	US
Telephone Number	:	214-528-3007
Fax Number	:

Provider Business Practice Location Address
First Line	:	3609 CEDAR SPRINGS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4905
Country	:	US
Telephone Number	:	214-528-3007
Fax Number	:

Authorized Official
Title or Position	:	MARRIAGE AND FAMILY THERAPIST
Name	:	DR. CAROL MCEWEN PHELPS
Credential	:	PH. D. LMFT
Telephone Number	:	214-528-3007

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	10/09/2009

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