Provider Demographics
NPI:1851903926
Name:SOLLOM, MATIA (LMFT)
Entity Type:Individual
Prefix:
First Name:MATIA
Middle Name:
Last Name:SOLLOM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 COUNTY ROAD 101 STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4157
Mailing Address - Country:US
Mailing Address - Phone:952-932-7277
Mailing Address - Fax:
Practice Address - Street 1:5125 COUNTY ROAD 101 STE 300
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4157
Practice Address - Country:US
Practice Address - Phone:952-932-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3479106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist