Provider Demographics
NPI:1407425200
Name:SOLACE BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:SOLACE BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOTIE-EBOH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP, ANP
Authorized Official - Phone:832-831-3651
Mailing Address - Street 1:16520 STEINHAGEN RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7173
Mailing Address - Country:US
Mailing Address - Phone:832-831-3651
Mailing Address - Fax:832-831-3652
Practice Address - Street 1:21922 BELLAIRE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3919
Practice Address - Country:US
Practice Address - Phone:832-831-3651
Practice Address - Fax:832-831-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health