Provider Demographics
NPI:1053674010
Name:SOLES, ANDREA KATRINA (LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KATRINA
Last Name:SOLES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 177TH CIR W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8712
Mailing Address - Country:US
Mailing Address - Phone:651-983-5504
Mailing Address - Fax:
Practice Address - Street 1:9940 177TH CIR W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8712
Practice Address - Country:US
Practice Address - Phone:651-983-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1846106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist