Provider Demographics
NPI:1407127517
Name:POPP, JOYCE (LP)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:
Last Name:POPP
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 EMERSON AVE S APT 403
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2968
Mailing Address - Country:US
Mailing Address - Phone:612-377-5724
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLSON RD # 450
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1332
Practice Address - Country:US
Practice Address - Phone:952-929-3103
Practice Address - Fax:952-929-8038
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2081103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling