Fatai Adeshina Popoola, LICSW,LADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

24938 Issued in MN

Practice address

525 Portland Ave # Mc963
Minneapolis, MN 55415-1533

Phone

(612) 396-2280

NPI assigned

Oct 27, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Amazing Health L. L. C.

  • Psychiatric/Mental Health Nurse Practitioner
  • Saint Paul, MN
  • NPI 1750043410

  Multi-Specialty

  Medicare reassignment NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  MN, Multi-Specialty

  Medicare reassignment NPD
• Hope Counseling LLC

  • Addiction (Substance Use Disorder) Counselor
  • Stillwater, MN
  • NPI 1316555188
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738800000000",
    "number": "1174035331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 PORTLAND AVE # MC963",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151533",
            "telephone_number": "612-396-2280",
            "fax_number": "612-466-9432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 PORTLAND AVE # MC963",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151533",
            "telephone_number": "612-396-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPOOLA",
        "first_name": "FATAI",
        "middle_name": "ADESHINA",
        "credential": "LICSW,LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-10-27",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303521",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "24938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael K Popkin, MD
• Jonathan Stanley Popko, CNP
• Poplar Grove Counseling, PLLP
• Constance Poplos, MD, MS
• Emily Dianne Popma, MD
• Jordan Popp, CRNA
• Sophia M Poppert, PA-C
• Barbara Ann Popplewell, RN
• Poppy and Jade Therapy Collective
• Jonathan Lee Poquiz, PHD

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.