Provider Demographics
NPI:1295206175
Name:SOLLER, KRISTI LEE
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LEE
Last Name:SOLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HUNTING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1589
Mailing Address - Country:US
Mailing Address - Phone:419-351-9163
Mailing Address - Fax:
Practice Address - Street 1:4159 N HOLLAND SYLVANIA RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4803
Practice Address - Country:US
Practice Address - Phone:419-318-5286
Practice Address - Fax:419-277-0091
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801510101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor