Provider Demographics
NPI:1144230186
Name:SOLACE COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:SOLACE COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:ODEA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-522-4640
Mailing Address - Street 1:1475 PRUDENTIAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-4109
Mailing Address - Country:US
Mailing Address - Phone:214-522-4640
Mailing Address - Fax:214-522-4650
Practice Address - Street 1:1475 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-4109
Practice Address - Country:US
Practice Address - Phone:214-522-4640
Practice Address - Fax:214-522-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14647101Y00000X
TX15717101Y00000X
TX24933103TC0700X
TXJ44232084A0401X
TX2174-A251S00000X
TX3312261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150488801Medicaid