Provider Demographics
NPI:1073710216
Name:HOLLINS, URSULA LYNETTE (MSW, LPN, LAC)
Entity Type:Individual
Prefix:MS
First Name:URSULA
Middle Name:LYNETTE
Last Name:HOLLINS
Suffix:
Gender:F
Credentials:MSW, LPN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 RANGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1705
Mailing Address - Country:US
Mailing Address - Phone:720-987-7242
Mailing Address - Fax:
Practice Address - Street 1:275 W ABRIENDO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1870
Practice Address - Country:US
Practice Address - Phone:719-621-1929
Practice Address - Fax:719-621-4974
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN.0049147164W00000X
COACD.0001734101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPN.0049147OtherLICENSED PRACTICAL NURSE
COACD.0001734OtherLAC