Provider Demographics
NPI:1407547755
Name:EQUINE EMPOWERED COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:EQUINE EMPOWERED COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:QUIGLEY-HOLMBECK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-343-2636
Mailing Address - Street 1:9364 E 1175TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61326-9486
Mailing Address - Country:US
Mailing Address - Phone:815-343-2636
Mailing Address - Fax:
Practice Address - Street 1:5220 HATTONS RD
Practice Address - Street 2:
Practice Address - City:HENNEPIN
Practice Address - State:IL
Practice Address - Zip Code:61327-5022
Practice Address - Country:US
Practice Address - Phone:815-343-2636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty