Organization
CHRYSALIS UTAH, LLC
Active
Other names
Chrysalis
Organization subpart
No
Provider details
NPI number
Authorized official
MARC ROBERT CHRISTENSEN MMHC (CHIEF OPERATIONS OFFICER)
(801) 655-4950
Entity
Organization
Contact information
Practice address
1443 W 800 N, SUITE 103, OREM, UT 84057-2875
(801) 655-4950
(801) 655-4954
Mailing address
1443 W 800 N, SUITE 103, OREM, UT 84057-2875
(801) 655-4950
(801) 655-4954
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
788007788140
—
UT
Enumeration date
09/06/2006
Last updated
07/21/2022
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