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General NPI Number Information
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NPI Number | 1124878285
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Entity Type | Organization
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Legal Business Name | EQUANIMITY COUNSELING AND PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 03/22/2024
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 1462 US HIGHWAY 395 N
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City | GARDNERVILLE
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State | NV
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Zip | 89410-5203
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Country | US
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Telephone | 775-553-0668
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Fax | 775-319-5922
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Provider Business Mailing Address
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Address Line | 6700 N LINDER RD, STE 156A #331
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City | MERIDIAN
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State | ID
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Zip | 83646
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Country | US
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Telephone | 775-553-0668
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Fax | 775-319-5922
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | MARY ANGELA PULIDO-BANNER
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Credential | PHD
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Telephone | 775-553-0668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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