Provider Demographics
NPI:1427516574
Name:POWER OF PROGRESS SERVICES, LLC
Entity type:Organization
Organization Name:POWER OF PROGRESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUTIER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:952-334-8278
Mailing Address - Street 1:881 MCINTOSH DR
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8971
Mailing Address - Country:US
Mailing Address - Phone:952-334-8278
Mailing Address - Fax:952-431-2679
Practice Address - Street 1:881 MCINTOSH DR
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-8971
Practice Address - Country:US
Practice Address - Phone:952-334-8278
Practice Address - Fax:952-431-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN101604100Medicaid