Individual
MR. JERRY LEE HOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, LPCC LADC
Contact information
Practice address
13895 INDUSTRIAL PARK BLVD, PLYMOUTH, MN 55441-3700
(763) 300-6707
(763) 559-2116
Mailing address
13895 INDUSTRIAL PARK BLVD, PLYMOUTH, MN 55441-3700
(763) 300-6707
(763) 559-2116
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
302560
MN
101YM0800X
Mental Health Counselor
Primary
00416
MN
101YM0800X
Mental Health Counselor
LPC00797
MN
Other
Enumeration date
11/04/2010
Last updated
07/10/2012
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