Provider Demographics
NPI:1659648228
Name:SOLITRO, JON PAUL (LLPC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:PAUL
Last Name:SOLITRO
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4581 TOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1125
Mailing Address - Country:US
Mailing Address - Phone:517-802-8085
Mailing Address - Fax:
Practice Address - Street 1:4581 TOLLAND AVE
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1125
Practice Address - Country:US
Practice Address - Phone:517-802-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health