MEDICARE: ADAM PALOWSKI 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	101YM0800X	Mental Health Counselor	1970	MN

General Provider Information

NPI Number	:	1073081535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM PALOWSKI LPCC

Provider Business Mailing Address
First Line	:	38780 8TH AVE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6696
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10077 DOGWOOD ST NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-5286
Country	:	US
Telephone Number	:	612-676-1604
Fax Number	:

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

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	09/04/2019

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