Provider Demographics
NPI:1144937335
Name:SOLACE BEHAVIORAL HEALTH AND WELLNESS, PC
Entity type:Organization
Organization Name:SOLACE BEHAVIORAL HEALTH AND WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:OLSON-TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LPC
Authorized Official - Phone:402-261-0235
Mailing Address - Street 1:1541 CENTER PARK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1227
Mailing Address - Country:US
Mailing Address - Phone:402-261-0235
Mailing Address - Fax:402-261-0428
Practice Address - Street 1:1541 CENTER PARK RD STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1227
Practice Address - Country:US
Practice Address - Phone:402-601-2725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1104152289Medicaid