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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

Other

Enumeration date
03/07/2018
Last updated
03/07/2018
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