Provider Demographics
NPI:1912721770
Name:POPPY AND JADE THERAPY COLLECTIVE
Entity type:Organization
Organization Name:POPPY AND JADE THERAPY COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MELLICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-293-9192
Mailing Address - Street 1:5521 42ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2260
Mailing Address - Country:US
Mailing Address - Phone:612-293-9192
Mailing Address - Fax:
Practice Address - Street 1:5521 42ND AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2260
Practice Address - Country:US
Practice Address - Phone:612-293-9192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health