Provider Demographics
NPI:1124875273
Name:EQUILIBRIUM THERAPY SERVICES P.L.L.C.
Entity type:Organization
Organization Name:EQUILIBRIUM THERAPY SERVICES P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:763-878-8576
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-0416
Mailing Address - Country:US
Mailing Address - Phone:763-878-8576
Mailing Address - Fax:763-402-7537
Practice Address - Street 1:1110 CIMARRON TRL
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-4560
Practice Address - Country:US
Practice Address - Phone:763-878-8576
Practice Address - Fax:763-402-7537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health