Provider Demographics
NPI:1093566796
Name:SOLLERS, JESSICA AMBER (LASAC, BHP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:AMBER
Last Name:SOLLERS
Suffix:
Gender:F
Credentials:LASAC, BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10086 E PASEO DE LA MASADA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5231
Mailing Address - Country:US
Mailing Address - Phone:520-256-6996
Mailing Address - Fax:
Practice Address - Street 1:6944 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5308
Practice Address - Country:US
Practice Address - Phone:520-526-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-15530101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)