Provider Demographics
NPI:1356674329
Name:SOLACE MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SOLACE MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-341-4311
Mailing Address - Street 1:8840 MICHIGAN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1440
Mailing Address - Country:US
Mailing Address - Phone:317-341-4311
Mailing Address - Fax:
Practice Address - Street 1:8840 MICHIGAN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1440
Practice Address - Country:US
Practice Address - Phone:317-341-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000681A261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health