MEDICARE: SOLACE COUNSELING ASSOCIATES

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	101Y00000X	Counselor	14647	TX
2	101Y00000X	Counselor	15717	TX
3	103TC0700X	Clinical Psychologist	24933	TX
4	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	J4423	TX
5	251S00000X	Community/Behavioral Health Agency	2174-A	TX
6	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	3312	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144230186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLACE COUNSELING ASSOCIATES

Provider Business Mailing Address
First Line	:	1475 PRUDENTIAL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-4109
Country	:	US
Telephone Number	:	214-522-4640
Fax Number	:	214-522-4650

Provider Business Practice Location Address
First Line	:	1475 PRUDENTIAL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-4109
Country	:	US
Telephone Number	:	214-522-4640
Fax Number	:	214-522-4650

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	MR. JOHN NOEL ODEA
Credential	:	LPC
Telephone Number	:	214-522-4640

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	11/22/2010

Similar Medicare Providers

1154330405 — MR. JOHN NOEL O'DEA LPC
Practice Location Address:

1475 PRUDENTIAL DR
DALLAS, TX
75235-4109

Practice Phone: 214-522-4640
Practice Fax: 214-522-4650

1528078466 — DR. DHIREN B. PATEL DO
Practice Location Address:

1475 PRUDENTIAL DR
DALLAS, TX
75235-4109

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1174740351 — DR. VIRGINIA NEAL PHD, NP
Practice Location Address:

1475 PRUDENTIAL DR
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75235-4109

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1881853760 — JENNIFER ANNE FORSYTH M.D.
Practice Location Address:

5225 MAPLE AVE APT 4109
DALLAS, TX
75235-8458

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Practice Fax:

1417315128 — MR. JOHN D. FREEMAN JR. LPC
Practice Location Address:

1475 PRUDENTIAL DR
DALLAS, TX
75235-4109

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Practice Fax: 214-522-4650

1992393094 — HECTOR ALBERTO CHAIRES
Practice Location Address:

6401 MAPLE AVE APT 4109
DALLAS, TX
75235-5537

Practice Phone: 915-201-9112
Practice Fax:

Directions to “SOLACE COUNSELING ASSOCIATES ” Practice Location

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