| Chrysalis | |
|
1443 W 800 N Suite 103 Orem UT 84057-2875 | |
| (801) 655-4950 | |
| (801) 655-4954 |
| Full Name | Chrysalis |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Location | 1443 W 800 N, Orem, Utah |
| Authorized Official Name and Position | Marc Robert Christensen (CHIEF OPERATIONS OFFICER) |
| Authorized Official Contact | 8016554950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chrysalis 1443 W 800 N Suite 103 Orem UT 84057-2875 Ph: (801) 655-4950 | Chrysalis 1443 W 800 N Suite 103 Orem UT 84057-2875 Ph: (801) 655-4950 |
| NPI Number | 1891898045 |
|---|---|
| Provider Enumeration Date | 09/06/2006 |
| Last Update Date | 07/21/2022 |
| Certification Date | 05/28/2020 |
| Medicare PECOS PAC ID | 4284735846 |
|---|---|
| Medicare Enrollment ID | O20070726000156 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891898045 | NPI | - | NPPES |
| 788007788140 | Medicaid | UT |
| Provider Name | Terry R Routt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023212644 PECOS PAC ID: 8820199219 Enrollment ID: I20070730000531 |
| Provider Name | Richard L Adams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477756906 PECOS PAC ID: 9436250826 Enrollment ID: I20070730000549 |
| Provider Name | Douglas K Stone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487857918 PECOS PAC ID: 8022119429 Enrollment ID: I20070730000596 |
| Provider Name | Jason A Harrison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346256302 PECOS PAC ID: 1658472055 Enrollment ID: I20070730000614 |
| Provider Name | Cory Ruward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225353204 PECOS PAC ID: 8628193836 Enrollment ID: I20100910001135 |
| Provider Name | Christopher Jon Gravett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295066447 PECOS PAC ID: 6608043054 Enrollment ID: I20120203000017 |
| Provider Name | Amanda Hanson Stansfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104918424 PECOS PAC ID: 8224388749 Enrollment ID: I20180904003197 |
| Provider Name | Kimberly Burnett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487057584 PECOS PAC ID: 6305175928 Enrollment ID: I20190906003058 |
| Provider Name | Steven Christopher Clements |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679003453 PECOS PAC ID: 0143632638 Enrollment ID: I20210309003249 |
| Provider Name | Royal William Fryer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659704468 PECOS PAC ID: 7618312737 Enrollment ID: I20240228004200 |
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