=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780474270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EQUINOX COUNSELING SOLUTIONS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2025
-----------------------------------------------------
Last Update Date | 08/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6850 AUSTIN CENTER BLVD STE 320
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78731-3154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-646-6903
-----------------------------------------------------
Fax | 210-830-5632
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6850 AUSTIN CENTER BLVD STE 320
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78731-3154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-646-6903
-----------------------------------------------------
Fax | 210-830-5632
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | MRS. MARTHA VILLAFRADE-BLUME
-----------------------------------------------------
Credential | LCSW, BCD
-----------------------------------------------------
Telephone | 210-201-2649
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------