| Chrysalis Psychological Services, PLLC | |
|
156 W Michigan Ave Ste 525 Jackson MI 49201-1302 | |
| (517) 262-0198 | |
| Not Available |
| Full Name | Chrysalis Psychological Services, PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 156 W Michigan Ave Ste 525, Jackson, Michigan |
| Authorized Official Name and Position | Jayde Kennedy-ball (OWNER) |
| Authorized Official Contact | 5172620198 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chrysalis Psychological Services, PLLC 156 W Michigan Ave Ste 525 Jackson MI 49201-1302 Ph: (517) 262-0198 | Chrysalis Psychological Services, PLLC 156 W Michigan Ave Ste 525 Jackson MI 49201-1302 Ph: (517) 262-0198 |
| NPI Number | 1407528920 |
|---|---|
| Provider Enumeration Date | 10/03/2021 |
| Last Update Date | 10/03/2021 |
| Certification Date | 09/13/2021 |
| Medicare PECOS PAC ID | 6901298900 |
|---|---|
| Medicare Enrollment ID | O20220125002863 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407528920 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (NU) | Primary |
| Provider Name | Jayde a Kennedy-ball |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225345077 PECOS PAC ID: 2163718024 Enrollment ID: I20160901002303 |
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