Healthcare Provider Details

I. General information

NPI: 1184423782
Provider Name (Legal Business Name): EQUILIBRIUM PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 SEMINOLE HWY
MADISON WI
53711-3812
US

IV. Provider business mailing address

1806 SEMINOLE HWY
MADISON WI
53711-3812
US

V. Phone/Fax

Practice location:
  • Phone: 612-741-4022
  • Fax: 608-608-8418
Mailing address:
  • Phone: 608-492-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SIRI M PETERSON
Title or Position: OWNER
Credential: LMFT
Phone: 612-741-4022