Provider Demographics
NPI:1124878285
Name:EQUANIMITY COUNSELING AND PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:EQUANIMITY COUNSELING AND PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:PULIDO-BANNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-553-0668
Mailing Address - Street 1:6700 N LINDER RD, STE 156A
Mailing Address - Street 2:#331
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:775-553-0668
Mailing Address - Fax:775-319-5922
Practice Address - Street 1:1462 US HIGHWAY 395 N
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5203
Practice Address - Country:US
Practice Address - Phone:775-553-0668
Practice Address - Fax:775-319-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health