Provider Demographics
NPI:1578744355
Name:SOLARITY MENTAL HEALTH, PC
Entity Type:Organization
Organization Name:SOLARITY MENTAL HEALTH, PC
Other - Org Name:SOLARITY MENTAL HEALTH, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOLYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-763-1778
Mailing Address - Street 1:PO BOX 18180
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305
Mailing Address - Country:US
Mailing Address - Phone:503-763-1778
Mailing Address - Fax:503-980-7888
Practice Address - Street 1:3787 RIVER RD NORTH
Practice Address - Street 2:RIVER RD PLAZA SUITE A
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303
Practice Address - Country:US
Practice Address - Phone:503-763-1778
Practice Address - Fax:503-980-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR095000354RN163WP0807X
OR200350049NP251S00000X, 363LP0808X
OR363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240505Medicaid