Healthcare Provider Details

I. General information

NPI: 1568396992
Provider Name (Legal Business Name): EQUINOX INTEGRATIVE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 SW CENTURY DR STE 4
BEND OR
97702-1167
US

IV. Provider business mailing address

19575 FISHER LAKE LN
BEND OR
97702-9181
US

V. Phone/Fax

Practice location:
  • Phone: 503-318-2335
  • Fax:
Mailing address:
  • Phone: 503-318-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DAVID M MACOMBER
Title or Position: OWNER/CLINICIAN
Credential: LPC
Phone: 503-318-2335