Healthcare Provider Details

I. General information

NPI: 1811579030
Provider Name (Legal Business Name): INNER EQUINOX COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 US HIGHWAY 14 STE 220A
CRYSTAL LAKE IL
60012-2711
US

IV. Provider business mailing address

215 FENIMORE RD
CRYSTAL LAKE IL
60014-7377
US

V. Phone/Fax

Practice location:
  • Phone: 224-338-6038
  • Fax:
Mailing address:
  • Phone: 224-338-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE ANN KRC GERLACH
Title or Position: CLINICAL THERAPIST
Credential: LCSW
Phone: 224-338-6038