Provider Demographics
NPI:1043577877
Name:EQUINOX COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:EQUINOX COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-450-2798
Mailing Address - Street 1:7745 S 2325 E
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5668
Mailing Address - Country:US
Mailing Address - Phone:801-450-2798
Mailing Address - Fax:
Practice Address - Street 1:923 E EXECUTIVE PARK DR
Practice Address - Street 2:SUITE E
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-7263
Practice Address - Country:US
Practice Address - Phone:801-450-2798
Practice Address - Fax:801-266-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty