Provider Demographics
NPI:1942400270
Name:SOLLY, DAVID C (DED)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:SOLLY
Suffix:
Gender:M
Credentials:DED
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7855 PINE CONE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-6117
Mailing Address - Country:US
Mailing Address - Phone:719-338-4665
Mailing Address - Fax:719-495-7458
Practice Address - Street 1:1880 OFFICE CLUB PT
Practice Address - Street 2:SUITE 4300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-5002
Practice Address - Country:US
Practice Address - Phone:719-272-8310
Practice Address - Fax:719-282-6006
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2835103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
16580OtherUSAA
CO31877265Medicaid
P00179191OtherRAILROAD MEDICARE (PALMET
673556OtherANTHEM AMIS
229050OtherUNITED HEALTHCARE
61-00623OtherEVERCARE
673556OtherANTHEM AMIS