MEDICARE: SOLACE CLINICAL COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP1600X	Pastoral Counselor
2	1041C0700X	Clinical Social Worker
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1568268142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLACE CLINICAL COUNSELING, LLC

Provider Business Mailing Address
First Line	:	16169 OLD MANSFIELD RD
Second Line	:
City	:	FREDERICKTOWN
State	:	OH
Zip	:	43019-9604
Country	:	US
Telephone Number	:	740-507-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	3880 CLIME RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-3532
Country	:	US
Telephone Number	:	740-507-0606
Fax Number	:

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	HALEY MCCOY
Credential	:	LISW-S
Telephone Number	:	740-507-0606

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	02/24/2025

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