Healthcare Provider Details

I. General information

NPI: 1912695461
Provider Name (Legal Business Name): AVA ELIZABETH GROVER MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 UNIVERSITY AVE W STE 6
SAINT PAUL MN
55104-3435
US

IV. Provider business mailing address

3753 FREMONT AVE N
MINNEAPOLIS MN
55412-2013
US

V. Phone/Fax

Practice location:
  • Phone: 651-641-1555
  • Fax: 651-641-0340
Mailing address:
  • Phone: 612-440-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC03600
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: