MEDICARE: MADELINE GOULD LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	5481	MN

General Provider Information

NPI Number	:	1043166036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE GOULD LPCC

Provider Business Mailing Address
First Line	:	3220 GIRARD AVE S APT 107
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3465
Country	:	US
Telephone Number	:	712-240-0654
Fax Number	:

Provider Business Practice Location Address
First Line	:	10579 165TH ST W STE B
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-3536
Country	:	US
Telephone Number	:	612-249-0287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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