Healthcare Provider Details

I. General information

NPI: 1073710216
Provider Name (Legal Business Name): URSULA LYNETTE HOLLINS MSW, LPN, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W ABRIENDO AVE
PUEBLO CO
81004-1870
US

IV. Provider business mailing address

2120 RANGEVIEW DR
PUEBLO CO
81008-1705
US

V. Phone/Fax

Practice location:
  • Phone: 719-621-1929
  • Fax: 719-621-4974
Mailing address:
  • Phone: 720-987-7242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0001734
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.0049147
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: