| Doctor Name: | MS. MARY ELLEN SOLOMON |
| NPI Number: | 1407103138 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 107 N Main St Kingfisher, OK - 737502720 |
| Business Phone Number: | 4053753735 |
| Business Fax Number: | 4053753987 |
| Mailing Address: | 1955 S Shepard Ave, Apt 412 EL RENO |
| State: | OK |
| Postal Code: | 730366369 |
| Phone Number: | 4054222989 |
| Fax Number: | 4054222989 |
| NPI Enumeration Date: | 08/13/2012 |
| NPI Last Update Date: | 08/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |