CHRYSALIS COMMUNITY COUNSELING SERVICES (NPI# 1780055897) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780055897 |
| Entity Type | Organization |
| Organization Name | CHRYSALIS COMMUNITY COUNSELING SERVICES |
| Practice Address |
1821 4th St Santa Rosa CA 95404-3202 |
| Practice Telephone | 7075457670 |
| Practice Fax Number | 7075453715 |
| Mailing Telephone | 7075457670 |
| Mailing Fax Number | 7075453715 |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2015-10-14 |
| Authorized Official Name | LISA MATHIESEN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7075451670 |
| Authorized Official Credential | MPA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
CA | Ambulatory Health Care Facilities |
| Street Address |
1821 4TH ST |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95404-3202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255448882 | Rhonda Shea | Marriage & Family Therapist | 1821 4th St, Santa Rosa, CA 95404-3202 | 2006-08-23 |
| 1215593447 | Nancy Herrera-cheng | Counselor | 1821 4th St, Santa Rosa, CA 95404-3202 | 2019-05-13 |
| 1396190468 | Carmen Carnes | Community Health Worker | 1821 4th St, Santa Rosa, CA 95404-3202 | 2016-04-26 |
| 1821452434 | Diane Camurat | Marriage & Family Therapist | 1821 4th St, Santa Rosa, CA 95404-3202 | 2016-04-09 |
| 1538523378 | Rex Burington | Marriage & Family Therapist | 1821 4th St, Santa Rosa, CA 95404-3202 | 2016-04-07 |
| 1396110961 | Joseph Harry Wheeler | Marriage & Family Therapist | 1821 4th St, Santa Rosa, CA 95404-3202 | 2015-12-08 |
| 1174997951 | Sivi Ruder | Counselor | 1821 4th St, Santa Rosa, CA 95404-3202 | 2015-11-17 |
| 1831326180 | Heather Ann Harshbarger | Marriage & Family Therapist | 1821 4th St, Santa Rosa, CA 95404-3202 | 2009-06-14 |
| 1194840660 | Cynthia Lynn Weissbein Macken | Psychologist | 1821 4th St, Santa Rosa, CA 95404-3202 | 2007-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205442217 | David Lee Dutton | Counselor | 201 S. E Street, Santa Rosa, CA 95404 | 2020-09-16 |
| 1114492162 | Jesse Earl Rathbun Jr. | Ophthalmology | 1920 Grace Dr., Santa Rosa, CA 95404 | 2018-10-05 |
| 1568958437 | Bianca Avina | Marriage & Family Therapist | 95 Montgomery Dr. #112, Santa Rosa, CA 95404 | 2018-07-03 |
| 1366940504 | New Leaf Counseling and Psychotherapy | Marriage & Family Therapist | 1030 2n Street, Suite B, Santa Rosa, CA 95404 | 2018-01-23 |
| 1659884864 | Jessica Vargas Lopez | Counselor | 3333 Chanate Road, Santa Rosa, CA 95404 | 2017-11-09 |
| 1982135992 | Gaea Keridwyn Coon | Marriage & Family Therapist | 884 Third Street, Suite D, Santa Rosa, CA 95404 | 2017-03-22 |
| 1376084699 | Empire Traditional Chinese Medicine | Acupuncturist | 1030 Second St, Santa Rosa, CA 95404 | 2017-03-20 |
| 1356888705 | Webster Surgery Center, Lp | Clinic/Center | 730 Bennett Valley Road, Santa Rosa, CA 95404 | 2017-01-24 |
| 1205295979 | Sandra Lee Krikorian | Social Worker | 101 E Street, Suite 312, Santa Rosa, CA 95404 | 2016-02-23 |
| 1396134615 | The Center for Body Oriented Psychotherapy & Wellness | Psychologist | 1626 Fourth Street, Santa Rosa, CA 95404 | 2015-01-12 |
| Find all providers in zip 95404 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386120442 | County of Sonoma | Clinic/Center | 2235 Challenger Way Ste 107 - 108, Santa Rosa, CA 95407-5421 | 2018-07-12 |
| 1356854673 | Sonoma Therapy Network | Clinic/Center | 3438 Mendocino Ave Ste B, Santa Rosa, CA 95403-2275 | 2017-11-08 |
| 1487863866 | County of Sonoma | Clinic/Center | 2227 Capricorn Way, Santa Rosa, CA 95407-5478 | 2007-05-22 |
| 1255547600 | Department of Health Services | Clinic/Center | 415 Humboldt St, Santa Rosa, CA 95404-4214 | 2007-05-15 |
| 1457567802 | County of Sonoma | Clinic/Center | 2235 Challenger Way Ste 101, Santa Rosa, CA 95407-5421 | 2007-05-15 |
| 1306050828 | County of Sonoma | Clinic/Center | 112 Childrens Cir, Santa Rosa, CA 95409-6558 | 2007-05-10 |
| 1407068992 | Department of Health Services | Clinic/Center | 617 W 9th St, Santa Rosa, CA 95401-5438 | 2007-05-04 |
| 1639207103 | Department of Health Services | Clinic/Center | 3400 Chanate Rd, Santa Rosa, CA 95404-1710 | 2007-02-28 |
| 1285120493 | County of Sonoma | Clinic/Center | 2245 Challenger Way Ste 100, Santa Rosa, CA 95407-5418 | 2018-07-11 |
| 1386130599 | County of Sonoma | Clinic/Center | 2227 Capricorn Way Ste 207, Santa Rosa, CA 95407-5486 | 2018-07-11 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 95404 |
Please comment or provide details below to improve the information on CHRYSALIS COMMUNITY COUNSELING SERVICES.
| 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.