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Organization
CHRYSALIS UTAH, INC.
Active
Organization
CHRYSALIS UTAH, INC.
Active
Parent organization
CHRYSALIS UTAH, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHRYSALIS UTAH, INC.
Authorized official
RICHARD SLACK (CFO)
(801) 655-4950
Entity
Organization
Contact information
Practice address
1507 S 180 E, PROVO, UT 84606-5570
(801) 426-6661
Mailing address
1443 W 800 N STE 103, OREM, UT 84057-2878
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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