Healthcare Provider Details

I. General information

NPI: 1598502528
Provider Name (Legal Business Name): SETS OF SOLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NW 4TH ST
EVANSVILLE IN
47708-1300
US

IV. Provider business mailing address

220 NW 4TH ST
EVANSVILLE IN
47708-1300
US

V. Phone/Fax

Practice location:
  • Phone: 812-250-8989
  • Fax:
Mailing address:
  • Phone: 812-250-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA COBB
Title or Position: DIRECTOR
Credential: LMHC
Phone: 812-250-8989