Provider Demographics
NPI:1194849935
Name:HOLDEN, DUSTIN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N 2ND AVE E
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2102
Mailing Address - Country:US
Mailing Address - Phone:218-722-1920
Mailing Address - Fax:218-722-1920
Practice Address - Street 1:8 N 2ND AVE E
Practice Address - Street 2:SUITE 310
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2102
Practice Address - Country:US
Practice Address - Phone:218-722-1920
Practice Address - Fax:218-722-1920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN081463000Medicaid