Healthcare Provider Details

I. General information

NPI: 1124875273
Provider Name (Legal Business Name): EQUILIBRIUM THERAPY SERVICES P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 CIMARRON TRL
ISANTI MN
55040-4560
US

IV. Provider business mailing address

PO BOX 416
ISANTI MN
55040-0416
US

V. Phone/Fax

Practice location:
  • Phone: 763-878-8576
  • Fax: 763-402-7537
Mailing address:
  • Phone: 763-878-8576
  • Fax: 763-402-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARGARET LIGHT
Title or Position: OWNER/THERAPIST
Credential: MA, LMFT
Phone: 763-878-8576