Provider Demographics
NPI:1447572151
Name:SOLOPOW, SHELLY
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:SOLOPOW
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 1:1633 FILLMORE ST
Mailing Address - Street 2:STE GL1
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1514
Mailing Address - Country:US
Mailing Address - Phone:303-953-6600
Mailing Address - Fax:303-781-4333
Practice Address - Street 1:1633 FILLMORE ST
Practice Address - Street 2:STE GL1
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1514
Practice Address - Country:US
Practice Address - Phone:303-953-6600
Practice Address - Fax:303-781-4333
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6695101YA0400X
CO5459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6023058Medicaid