Healthcare Provider Details

I. General information

NPI: 1043577877
Provider Name (Legal Business Name): EQUINOX COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 E EXECUTIVE PARK DR SUITE E
HOLLADAY UT
84117-7263
US

IV. Provider business mailing address

7745 S 2325 E
COTTONWOOD HEIGHTS UT
84121-5668
US

V. Phone/Fax

Practice location:
  • Phone: 801-450-2798
  • Fax: 801-266-3706
Mailing address:
  • Phone: 801-450-2798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ISAAC MICHAEL PHILLIPS
Title or Position: DIRECTOR
Credential: LCSW
Phone: 801-450-2798