Active NPI
Holly Dutton
- Professional Counselor
- Detroit Lakes, MN
National Provider Identifier
1427439223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 01689
- Practice address
- 910 Lincoln Ave
Detroit Lakes, MN 56501-3500 - Phone
- (701) 451-4900
- Fax
- (701) 451-5056
- NPI assigned
- Jun 17, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 01689 | MN | Primary |
| Professional Counselor | 101YP2500X | 543 | NE |
Addresses
Primary practice location
910 Lincoln Ave
Detroit Lakes, MN 56501-3500
Mailing address
PO Box 9859
Fargo, ND 58106-9859
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01689 | MN | MD | Professional Counselor |
| 543 | NE | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Village Family Service Center | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba The Village Family Service Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fargo, ND
- NPI 1568492353
Professional
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434499200000",
"number": "1427439223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9859",
"city": "FARGO",
"state": "ND",
"postal_code": "581069859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "910 LINCOLN AVE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565013500",
"telephone_number": "701-451-4900",
"fax_number": "701-451-5056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUTTON",
"first_name": "HOLLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-17",
"last_updated": "2015-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "01689",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NE",
"license": "543",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.