MEDICARE: AWAKENED PATH COUNSELING

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1609764869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWAKENED PATH COUNSELING

Provider Business Mailing Address
First Line	:	15322 GALAXIE AVE STE 204
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-3150
Country	:	US
Telephone Number	:	952-222-8193
Fax Number	:

Provider Business Practice Location Address
First Line	:	15322 GALAXIE AVE STE 204
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-3150
Country	:	US
Telephone Number	:	952-222-8193
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NICOLE NIEDFELDT
Credential	:
Telephone Number	:	952-222-8193

Provider Enumeration Date	:	06/26/2025
Last Update Date	:	06/24/2026

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Directions to “AWAKENED PATH COUNSELING ” Practice Location

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