Provider Demographics
NPI:1851473201
Name:SOLES, SANDRA KAY (MSLPC)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:KAY
Last Name:SOLES
Suffix:
Gender:F
Credentials:MSLPC
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:KAY
Other - Last Name:SOLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:3833 S STAPLES ST
Mailing Address - Street 2:SUITE N-206
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5201
Mailing Address - Country:US
Mailing Address - Phone:361-779-4373
Mailing Address - Fax:361-334-3582
Practice Address - Street 1:3833 S STAPLES ST
Practice Address - Street 2:SUITE N-206
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5201
Practice Address - Country:US
Practice Address - Phone:361-779-4373
Practice Address - Fax:361-334-3582
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168502602Medicaid