MEDICARE: EQUANIMITY COUNSELING & CONSULTATION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	E7723	OH

General Provider Information

NPI Number	:	1588009054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUANIMITY COUNSELING & CONSULTATION, LLC

Provider Business Mailing Address
First Line	:	1508 HESS ST
Second Line	:
City	:	GRANDVIEW
State	:	OH
Zip	:	43212-2679
Country	:	US
Telephone Number	:	614-999-4122
Fax Number	:	888-216-8339

Provider Business Practice Location Address
First Line	:	1508 HESS ST
Second Line	:
City	:	GRANDVIEW
State	:	OH
Zip	:	43212-2679
Country	:	US
Telephone Number	:	614-999-4122
Fax Number	:	888-216-8339

Authorized Official
Title or Position	:	OWNER, CLINICAL COUNSELOR
Name	:	NANCY A. LITTLE
Credential	:	PCC
Telephone Number	:	614-999-4122

Provider Enumeration Date	:	05/09/2013
Last Update Date	:	05/09/2013

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