Healthcare Provider Details

I. General information

NPI: 1982241428
Provider Name (Legal Business Name): EQUILIBRIUM MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 N NORTHSIGHT BLVD STE 217
SCOTTSDALE AZ
85260-3677
US

IV. Provider business mailing address

8776 E SHEA BLVD STE 106
SCOTTSDALE AZ
85260-6687
US

V. Phone/Fax

Practice location:
  • Phone: 480-616-9560
  • Fax:
Mailing address:
  • Phone: 480-616-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE SHADIX
Title or Position: OWNER/PSYCHIATRIC ARNP
Credential: MN, ARNP
Phone: 480-616-9560