Healthcare Provider Details

I. General information

NPI: 1578744355
Provider Name (Legal Business Name): SOLARITY MENTAL HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 RIVER RD NORTH RIVER RD PLAZA SUITE A
KEIZER OR
97303
US

IV. Provider business mailing address

PO BOX 18180
SALEM OR
97305
US

V. Phone/Fax

Practice location:
  • Phone: 503-763-1778
  • Fax: 503-980-7888
Mailing address:
  • Phone: 503-763-1778
  • Fax: 503-980-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number095000354RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number200350049NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200350049NP
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateOR

VIII. Authorized Official

Name: MS. JOLYN ANN ZELLER
Title or Position: OWNER
Credential: PMHNP
Phone: 503-763-1778