Healthcare Provider Details

I. General information

NPI: 1609764869
Provider Name (Legal Business Name): AWAKENED PATH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15322 GALAXIE AVE STE 204
APPLE VALLEY MN
55124-3150
US

IV. Provider business mailing address

15322 GALAXIE AVE STE 204
APPLE VALLEY MN
55124-3150
US

V. Phone/Fax

Practice location:
  • Phone: 952-222-8193
  • Fax:
Mailing address:
  • Phone: 952-222-8193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE NIEDFELDT
Title or Position: PRESIDENT
Credential:
Phone: 952-222-8193