Provider Demographics
NPI:1194162693
Name:CHRYSALIS: MENTAL HEALTH & TRAUMA SPECIALISTS, LLC
Entity type:Organization
Organization Name:CHRYSALIS: MENTAL HEALTH & TRAUMA SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PROFESSIONAL COUNSEL
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ROGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:412-889-2142
Mailing Address - Street 1:130 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST ALEXANDER
Mailing Address - State:PA
Mailing Address - Zip Code:15376
Mailing Address - Country:US
Mailing Address - Phone:304-280-0713
Mailing Address - Fax:
Practice Address - Street 1:102 BROADWAY STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106
Practice Address - Country:US
Practice Address - Phone:412-889-2142
Practice Address - Fax:412-875-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1811264484OtherINDIVIDUAL NPI