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General NPI Number Information
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NPI Number | 1134932957
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Entity Type | Individual
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Provider Name | SAMUEL DYLAN GOBEL LPCC
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Gender | Male
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 928 8TH ST SE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-2839
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Country | US
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Telephone | 218-847-1676
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Fax |
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Provider Business Mailing Address
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Address Line | 26510 COUNTY ROAD 149
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City | DETROIT LAKES
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State | MN
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Zip | 56501-7681
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 04776
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License Number State | MN
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