Provider Demographics
NPI:1225149651
Name:SOLOMON, ROB (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:ROB
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 SW WATSON AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0521
Mailing Address - Country:US
Mailing Address - Phone:503-644-9696
Mailing Address - Fax:503-643-4058
Practice Address - Street 1:4755 SW WATSON AVE
Practice Address - Street 2:STE 102
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0521
Practice Address - Country:US
Practice Address - Phone:503-644-9696
Practice Address - Fax:503-643-4058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health