Healthcare Provider Details

I. General information

NPI: 1396047296
Provider Name (Legal Business Name): ISHWARI SOLLOHUB MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2010
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 DON GASPAR AVE
SANTA FE NM
87505-2626
US

IV. Provider business mailing address

1222 SENDA DEL VALLE APT D
SANTA FE NM
87507-7766
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-1697
  • Fax:
Mailing address:
  • Phone: 505-231-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0166551
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: