Provider Demographics
NPI:1396047296
Name:SOLLOHUB, ISHWARI (MA, LMHC)
Entity type:Individual
Prefix:
First Name:ISHWARI
Middle Name:
Last Name:SOLLOHUB
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 SENDA DEL VALLE APT D
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7766
Mailing Address - Country:US
Mailing Address - Phone:505-231-1697
Mailing Address - Fax:
Practice Address - Street 1:532 DON GASPAR AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2626
Practice Address - Country:US
Practice Address - Phone:505-231-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-27
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0166551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health