Individual
MRS. HOLLY JEAN LINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
520 NW 5TH ST, BRAINERD, MN 56401-2902
(218) 829-3235
Mailing address
31121 HILLSIDE PASS, BREEZY POINT, MN 56472-3820
(218) 562-5804
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC00002
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00N15LI
BLUE CROSS BLUE SHIELD
MN
01
—
1044529
PREFERRED ONE
MN
01
—
1801958897
UCARE
MN
Enumeration date
12/15/2006
Last updated
01/08/2010
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