Provider Demographics
NPI:1083085989
Name:POPLAR GROVE COUNSELING, PLLP
Entity Type:Organization
Organization Name:POPLAR GROVE COUNSELING, PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KAASA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-578-5181
Mailing Address - Street 1:3011 36TH AVE S
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2796
Mailing Address - Country:US
Mailing Address - Phone:651-335-3799
Mailing Address - Fax:
Practice Address - Street 1:3011 36TH AVE S
Practice Address - Street 2:SUITE 9
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2796
Practice Address - Country:US
Practice Address - Phone:612-578-5181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN162681041C0700X
MN203071041C0700X
MN177101041C0700X
MN227161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty