Provider Demographics
NPI:1588993539
Name:CHRYSALIS COUNSELING, PLC
Entity type:Organization
Organization Name:CHRYSALIS COUNSELING, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR, CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MC NCC LPC
Authorized Official - Phone:602-481-5714
Mailing Address - Street 1:22 E CYDNEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3985
Mailing Address - Country:US
Mailing Address - Phone:602-481-5714
Mailing Address - Fax:
Practice Address - Street 1:22 E CYDNEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3985
Practice Address - Country:US
Practice Address - Phone:602-481-5714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty