Provider Demographics
NPI:1326663808
Name:SOLIS, KEISHA M
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:M
Last Name:SOLIS
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 1:99 W PALOMINO DR APT 208
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7713
Mailing Address - Country:US
Mailing Address - Phone:323-812-1216
Mailing Address - Fax:
Practice Address - Street 1:99 W PALOMINO DR APT 208
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7713
Practice Address - Country:US
Practice Address - Phone:323-812-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10079911103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst