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General NPI Number Information
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NPI Number | 1710552161
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Entity Type | Organization
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Legal Business Name | EQUILIBRIUM COUNSELING AND WELLNESS LLC
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 450 N 159TH ST E
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City | WICHITA
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State | KS
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Zip | 67230-7704
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Country | US
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Telephone | 316-530-1174
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Fax |
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Provider Business Mailing Address
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Address Line | 450 N 159TH ST E
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City | WICHITA
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State | KS
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Zip | 67230-7704
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Country | US
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Telephone | 316-530-1174
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Fax | 316-633-4174
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Authorized Official
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Title or Position | OWNER
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Name | BRITTNEY RENEE DOLL
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Credential | LCMFT
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Telephone | 316-530-1174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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