Provider Demographics
NPI:1992910814
Name:CHRYSALIS MENTAL HEALTH & WELLNESS INC.
Entity type:Organization
Organization Name:CHRYSALIS MENTAL HEALTH & WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING DIRECTOR/PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, CCDP-D
Authorized Official - Phone:412-889-2142
Mailing Address - Street 1:1074 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3140
Mailing Address - Country:US
Mailing Address - Phone:412-889-2142
Mailing Address - Fax:412-945-5120
Practice Address - Street 1:1074 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3140
Practice Address - Country:US
Practice Address - Phone:412-889-2142
Practice Address - Fax:412-945-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6784101YA0400X
PAPC0400048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty