Healthcare Provider Details

I. General information

NPI: 1750143749
Provider Name (Legal Business Name): MARYAH SOLIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

IV. Provider business mailing address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-652-3448
  • Fax:
Mailing address:
  • Phone: 575-652-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2022-0835
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: