Provider Demographics
NPI:1346903911
Name:EQUILIBRIUM MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:EQUILIBRIUM MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANIA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, PMHNP-BC
Authorized Official - Phone:314-707-5956
Mailing Address - Street 1:521 KENT DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1316
Mailing Address - Country:US
Mailing Address - Phone:314-707-5956
Mailing Address - Fax:
Practice Address - Street 1:5700 MEXICO RD STE 8
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1667
Practice Address - Country:US
Practice Address - Phone:636-477-6464
Practice Address - Fax:636-410-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)