Provider Demographics
NPI:1982241428
Name:EQUILIBRIUM MENTAL HEALTH, PLLC
Entity Type:Organization
Organization Name:EQUILIBRIUM MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIC ARNP
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADIX
Authorized Official - Suffix:
Authorized Official - Credentials:MN, ARNP
Authorized Official - Phone:480-616-9560
Mailing Address - Street 1:8776 E SHEA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6687
Mailing Address - Country:US
Mailing Address - Phone:480-616-9560
Mailing Address - Fax:
Practice Address - Street 1:14300 N NORTHSIGHT BLVD STE 217
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3677
Practice Address - Country:US
Practice Address - Phone:480-616-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty