Provider Demographics
NPI:1811579030
Name:INNER EQUINOX COUNSELING CENTER LLC
Entity type:Organization
Organization Name:INNER EQUINOX COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN KRC
Authorized Official - Last Name:GERLACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:224-338-6038
Mailing Address - Street 1:215 FENIMORE RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7377
Mailing Address - Country:US
Mailing Address - Phone:224-338-6038
Mailing Address - Fax:
Practice Address - Street 1:8600 US HIGHWAY 14 STE 220A
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-2711
Practice Address - Country:US
Practice Address - Phone:224-338-6038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400646798Medicaid