Provider Demographics
NPI:1154704534
Name:EQUIP COUNSELING LLC
Entity type:Organization
Organization Name:EQUIP COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:MATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-894-4347
Mailing Address - Street 1:4423 S MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1047
Mailing Address - Country:US
Mailing Address - Phone:417-894-4347
Mailing Address - Fax:
Practice Address - Street 1:4423 S MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-1047
Practice Address - Country:US
Practice Address - Phone:417-894-4347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-03
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015016664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty