Provider Demographics
NPI:1548077332
Name:POPPY AND SAGE COUNSELING PLLC
Entity type:Organization
Organization Name:POPPY AND SAGE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LCPC, NCC
Authorized Official - Phone:361-446-0602
Mailing Address - Street 1:PO BOX 18281
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-8281
Mailing Address - Country:US
Mailing Address - Phone:469-630-1615
Mailing Address - Fax:
Practice Address - Street 1:2713 OSHAUGHNESY ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1329
Practice Address - Country:US
Practice Address - Phone:469-630-1615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1386323681Medicaid