Provider Demographics
NPI:1750610622
Name:HOLTE, PAUL STRAND (LICENCED PSYCHOLOGIS)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:STRAND
Last Name:HOLTE
Suffix:
Gender:M
Credentials:LICENCED PSYCHOLOGIS
Other - Prefix:
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Mailing Address - Street 1:911 HOLMES ST S
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2414
Mailing Address - Country:US
Mailing Address - Phone:952-496-2565
Mailing Address - Fax:
Practice Address - Street 1:100 FREEMAN DR
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-3504
Practice Address - Country:US
Practice Address - Phone:507-985-2163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN0021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical