Healthcare Provider Details

I. General information

NPI: 1629756135
Provider Name (Legal Business Name): SOLACE COUNSELING SERVICES OF INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3528 MACPHERSON PL
CINCINNATI OH
45245-3093
US

IV. Provider business mailing address

3528 MACPHERSON PL
CINCINNATI OH
45245-3093
US

V. Phone/Fax

Practice location:
  • Phone: 765-918-1322
  • Fax: 513-752-1212
Mailing address:
  • Phone: 765-918-1322
  • Fax: 513-752-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH K ROBERTS
Title or Position: OWNER
Credential: MAMFT, LMFT, LCAC
Phone: 765-918-1322