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Organization
ARK COUNSELING
Active
Organization
ARK COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY LEE HOLT MA MPH LPCC LADC (PROGRAM DIRECTOR)
(763) 559-5677
Entity
Organization
Contact information
Practice address
13895 INDUSTRIAL PARK BLVD, PLYMOUTH, MN 55441-3723
(763) 559-5677
Mailing address
13895 INDUSTRIAL PARK BLVD, PLYMOUTH, MN 55441-3700
(763) 559-5677
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
302560
MN
101YM0800X
Mental Health Counselor
Primary
00416
MN
Other
Enumeration date
06/22/2011
Last updated
07/19/2012
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