Active NPI
Chrysalis Utah, LLC
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Orem, UT
National Provider Identifier
1891898045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Legal business name
- CHRYSALIS UTAH, LLC
- Practice address
- 1443 W 800 N
Suite 103
Orem, UT 84057-2875 - Phone
- (801) 655-4950
- Fax
- (801) 655-4954
- NPI assigned
- Sep 6, 2006
- Organization subpart
- No
Authorized official
NPPES NPI Registry- Name
- Marc Robert Christensen, MMHC
- Title
- Chief Operations Officer
- Phone
- (801) 655-4950
Practitioners 114
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Behavior Technician
- Provo, UT
- NPI 1598626582
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070726000156 | UT | Part B Supplier - Clinic/Group Practice | 4284735846 |
Receives reassigned benefits from 11 practitioners Practice locations: Cedar City, UT; Provo, UT |
National Provider Directory
National Provider Directory- Tax ID family
- Chrysalis Utah LLC
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Counselor
- Provo, UT
- NPI 1356843114
-
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Orem, UT
- NPI 1184033656
-
- Community/Behavioral Health Agency
- Reno, NV
- NPI 1588925267
-
- Community/Behavioral Health Agency
- Reno, NV
- NPI 1609256460
Locations
660 N Airport Rd
Cedar City, UT 84721
Phone (435) 477-2816
401 N 2150 W
Cedar City, UT 84721
Phone (435) 586-4078
525 W 465 N
Ste 120
Providence, UT 84332
Phone (307) 871-0695
1501 S 40 E
Ste 390
Provo, UT 84606
1185 E 300 N
Provo, UT 84606
Phone (801) 373-2215
1507 S 180 E
Provo, UT 84606
Phone (801) 426-6661
4933 S 1500 W
Ste 210
Riverdale, UT 84405
Phone (801) 604-1455
230 N 1680 E
Ste Op
St George, UT 84790
Phone (801) 604-1455
Specialties & licenses 3
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Behavior Analyst | 103K00000X | |||
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | UT | Primary |
Addresses
NPPES NPI RegistryPrimary practice location
1443 W 800 N
Suite 103
Orem, UT 84057-2875
Mailing address
1443 W 800 N
Suite 103
Orem, UT 84057-2875
Phone (801) 655-4950
Other identifiers 1
NPPES NPI Registry| Identifier | Type | State | Issuer |
|---|---|---|---|
| 788007788140 | Medicaid | UT |
Other names 1
NPPES NPI Registry- Chrysalis
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 21, 2022.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1891898045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1443 W 800 N",
"address_2": "SUITE 103",
"city": "OREM",
"state": "UT",
"postal_code": "840572875",
"telephone_number": "801-655-4950",
"fax_number": "801-655-4954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1443 W 800 N",
"address_2": "SUITE 103",
"city": "OREM",
"state": "UT",
"postal_code": "840572875",
"telephone_number": "801-655-4950",
"fax_number": "801-655-4954"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHRYSALIS UTAH, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-06",
"last_updated": "2022-07-21",
"certification_date": "2020-05-28",
"status": "A",
"authorized_official_last_name": "CHRISTENSEN",
"authorized_official_first_name": "MARC",
"authorized_official_middle_name": "ROBERT",
"authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
"authorized_official_telephone_number": "801-655-4950",
"authorized_official_credential": "MMHC"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "UT",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "788007788140",
"state": "UT"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Chrysalis",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "Chrysalis",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Orem, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.