Provider Demographics
NPI:1811433311
Name:SOLIS, SAMANTHA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:SOLIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112256
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-2256
Mailing Address - Country:US
Mailing Address - Phone:253-470-6948
Mailing Address - Fax:
Practice Address - Street 1:301 2ND AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3011
Practice Address - Country:US
Practice Address - Phone:253-470-6948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60925476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2095221Medicaid