Provider Demographics
NPI:1912497488
Name:THE EQUINE CONNECTION LLC
Entity Type:Organization
Organization Name:THE EQUINE CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORSHEAD-METELICA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC
Authorized Official - Phone:715-292-7022
Mailing Address - Street 1:85565 8 POINT LN
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54814-4479
Mailing Address - Country:US
Mailing Address - Phone:715-292-7022
Mailing Address - Fax:
Practice Address - Street 1:93600 LITTLE SAND BAY RD
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:WI
Practice Address - Zip Code:54814-4610
Practice Address - Country:US
Practice Address - Phone:715-600-0346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5806-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty