CHRYSALLIS WELLNESS CENTER INC (NPI# 1386272334) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386272334 |
| Entity Type | Organization |
| Organization Name | CHRYSALLIS WELLNESS CENTER INC |
| Practice Address |
11932 Faiway Lakes Fort Myers FL 33913 |
| Practice Telephone | 2397380926 |
| Mailing Telephone | 2397380926 |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2020-04-07 |
| Authorized Official Name | MISS MARIE CARMELLE BOISBEL (VICE PRESIDENT) |
| Authorized Official Telephone | 2397384307 |
| Authorized Official Credential | LMHC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Chrysallis Wellness Center Inc | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CHRYSALLIS WELLNESS CENTER INC | 11932 Fairway Lakes Dr, Fort Myers, FL 33913-8337 |
| Street Address |
11932 FAIWAY LAKES |
| City | FORT MYERS |
| State | FL |
| Zip Code | 33913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467079368 | Fq0014 | Clinic/Center | 11930 Fairway Lakes Dr, Ste 103, Fort Myers, FL 33913 | 2020-06-26 |
| 1811459399 | Kelly Christine Reynolds | Student in an Organized Health Care Education/Training Program | 11750 Rosemount Drive, Fort Myers, FL 33913 | 2019-04-03 |
| 1043784432 | Alex Richard Reynolds | Physician Assistant | 2700 Creekside Ln, Suit 101, Fort Myers, FL 33913 | 2019-01-18 |
| 1881196541 | Kara Seanor | Counselor | 12575 Stone Tower Loop, Fort Myers, FL 33913 | 2018-03-08 |
| 1063951515 | Publix Super Markets Inc | Durable Medical Equipment & Medical Supplies | 13121 Paul J. Doherty Pkwy, Fort Myers, FL 33913 | 2017-02-16 |
| 1518337492 | Barry K Butler P.a. | Internal Medicine | 10708 Bradbury Way, Fort Myers, FL 33913 | 2015-10-05 |
| 1811322886 | Bernard Timothy Renner | Pharmacist | 10000 Gulf Coast Town Center Drive, Ft. Myers, FL 33913 | 2013-09-10 |
| 1831531979 | Debra Anne Channer | Pharmacist | 12550 Professional Park Drive Unit 1, Walgreens Co., Ft. Myers, FL 33913 | 2013-07-17 |
| 1144572249 | Victoria Sydeco Tayengco-maisog | Pediatrics | 9304 Trieste Drive, Fort Myers, FL 33913 | 2012-10-12 |
| 1578848164 | David L. Lovell | Pharmacist | 10088 Gulf Center Drive, Costco Pharmacy 0621, Ft Myers, FL 33913 | 2011-10-15 |
| Find all providers in zip 33913 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902413305 | Shantell Pepe | Counselor | 4310 Metro Pkwy Ste 200, Fort Myers, FL 33916-9462 | 2020-09-29 |
| 1548879091 | Linda Ann Weaver | Counselor | 12811 Kenwood Ln Ste 202-213, Fort Myers, FL 33907-5667 | 2020-07-29 |
| 1710502166 | Cornerstone Consultants | Counselor | 1344 Bradford Rd, Fort Myers, FL 33901-8804 | 2020-06-11 |
| 1053935981 | Timothy D Solomon | Counselor | 12557 New Brittany Blvd Ste 31-2, Fort Myers, FL 33907-3651 | 2020-06-06 |
| 1487275418 | Hofmann Counseling and Consulting, LLC. | Counselor | 8925 Beacon Street, Fort Myers, FL 33907-3390 | 2020-04-30 |
| 1760002927 | Angela Maria Molina | Counselor | 11932 Fairway Lakes Dr, Fort Myers, FL 33913-8337 | 2020-04-17 |
| 1710512454 | Kelleen Marguerite Linden | Counselor | 12670 New Brittany Blvd Ste 204, Fort Myers, FL 33907-3650 | 2020-03-03 |
| 1194369355 | Mary Alice Robinson | Counselor | 4531 Deleon St Ste 206, Fort Myers, FL 33907-1280 | 2019-10-31 |
| 1942855580 | Susan Lee Bobrow | Counselor | 3049 Cleveland Ave Ste 295, Fort Myers, FL 33901-7054 | 2019-08-08 |
| 1124685029 | Sarah Elizabeth Scozzafava | Counselor | 4351 Skates Cir, Fort Myers, FL 33905-7333 | 2019-05-26 |
| Find all providers in FORT MYERS | ||||
| City | FORT MYERS |
| Zip Code | 33913 |
Please comment or provide details below to improve the information on CHRYSALLIS WELLNESS CENTER INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.