Provider Demographics
NPI:1629756135
Name:SOLACE COUNSELING SERVICES OF INDIANA LLC
Entity Type:Organization
Organization Name:SOLACE COUNSELING SERVICES OF INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MAMFT, LMFT, LCAC
Authorized Official - Phone:765-918-1322
Mailing Address - Street 1:3528 MACPHERSON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-3093
Mailing Address - Country:US
Mailing Address - Phone:765-918-1322
Mailing Address - Fax:513-752-1212
Practice Address - Street 1:3528 MACPHERSON PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-3093
Practice Address - Country:US
Practice Address - Phone:765-918-1322
Practice Address - Fax:513-752-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty