Provider Demographics
NPI:1821465188
Name:SOLIS, CARMEN (MA, MFTI)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:SOLIS
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 OVERLAND AVE
Mailing Address - Street 2:APT. 107
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4153
Mailing Address - Country:US
Mailing Address - Phone:559-813-0224
Mailing Address - Fax:
Practice Address - Street 1:1530 S OLIVE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3023
Practice Address - Country:US
Practice Address - Phone:213-747-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF87098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist