Provider Demographics
NPI:1487210159
Name:HOLT, MICHELLE CORRINE (LICSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CORRINE
Last Name:HOLT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-4500
Mailing Address - Country:US
Mailing Address - Phone:507-931-8040
Mailing Address - Fax:507-931-8060
Practice Address - Street 1:1306 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-4500
Practice Address - Country:US
Practice Address - Phone:507-931-8040
Practice Address - Fax:507-931-8060
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN227301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical