Provider Demographics
NPI:1336534742
Name:SOLOMON, PATRICK THOMAS (MA,, LPCA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:THOMAS
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MA,, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BLUEGRASS RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-2459
Mailing Address - Country:US
Mailing Address - Phone:270-253-3722
Mailing Address - Fax:
Practice Address - Street 1:215 BLUEGRASS RD UNIT C
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2459
Practice Address - Country:US
Practice Address - Phone:270-253-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional