Healthcare Provider Details

I. General information

NPI: 1154236248
Provider Name (Legal Business Name): CARLY SOLOME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S RAINBOW RD
ROGERS AR
72758-1637
US

IV. Provider business mailing address

901 S RAINBOW RD
ROGERS AR
72758-1637
US

V. Phone/Fax

Practice location:
  • Phone: 816-813-1640
  • Fax:
Mailing address:
  • Phone: 816-813-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number202300
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: