Provider Demographics
NPI:1669411526
Name:MATHIEU, HOLLEY J (MS)
Entity type:Individual
Prefix:
First Name:HOLLEY
Middle Name:J
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:HOLLEY
Other - Middle Name:J
Other - Last Name:MATHIEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:823 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3770
Mailing Address - Country:US
Mailing Address - Phone:218-841-2109
Mailing Address - Fax:
Practice Address - Street 1:823 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3770
Practice Address - Country:US
Practice Address - Phone:218-841-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3062103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN144528600Medicaid
MN1016931OtherPREFERREDONE
MN116591OtherUCARE MINNESOTA
MN51Q34AROtherBLUE SHIELD OF MINNESOTA
MNHP24141OtherHEALTHPARTNERS
MN62-02903OtherUNITED BEHAVIORAL HEALTH