MEDICARE: MR. WILLIAM PHILIP GRACZYK MPS, LADC, 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		MN

General Provider Information

NPI Number	:	1558050385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM PHILIP GRACZYK MPS, LADC, LPCC

Provider Business Mailing Address
First Line	:	17827 66TH AVE N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3972
Country	:	US
Telephone Number	:	612-845-3773
Fax Number	:

Provider Business Practice Location Address
First Line	:	17827 66TH AVE N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3972
Country	:	US
Telephone Number	:	612-845-3773
Fax Number	:

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/23/2023

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