Provider Demographics
NPI:1275099889
Name:EQUILA, SHAYLA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:EQUILA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26923
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-0923
Mailing Address - Country:US
Mailing Address - Phone:414-435-1115
Mailing Address - Fax:
Practice Address - Street 1:4025 N 92ND ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-1613
Practice Address - Country:US
Practice Address - Phone:414-435-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4272-226101YM0800X
WI8088-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health