Provider Demographics
NPI:1639690720
Name:SOLIS, MICHELLE (CCAPP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:SOLIS
Suffix:
Gender:F
Credentials:CCAPP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:SOLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCAPP
Mailing Address - Street 1:15229 AMAR RD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-2066
Mailing Address - Country:US
Mailing Address - Phone:626-855-5090
Mailing Address - Fax:626-961-1810
Practice Address - Street 1:15229 AMAR RD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-2066
Practice Address - Country:US
Practice Address - Phone:626-855-5090
Practice Address - Fax:626-961-1810
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1198220415101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)