Basic Information
| Provider Information | |||||||||
| NPI: | 1366798241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLOMON | ||||||||
| FirstName: | MARTINN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3435 W CRAIG RD | ||||||||
| Address2: | STE A | ||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890325115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027500377 | ||||||||
| FaxNumber: | 7025387928 | ||||||||
| Practice Location | |||||||||
| Address1: | 3435 W CRAIG RD | ||||||||
| Address2: | STE. A | ||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890325115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027500377 | ||||||||
| FaxNumber: | 7025387928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2012 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E3172673 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103K00000X | E3172673 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.