Healthcare Provider Details

I. General information

NPI: 1376245910
Provider Name (Legal Business Name): MR. MICHAEL STROM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 BURNHAVEN DR
BURNSVILLE MN
55306-4960
US

IV. Provider business mailing address

3913 EVERMOOR PKWY
ROSEMOUNT MN
55068-4389
US

V. Phone/Fax

Practice location:
  • Phone: 651-460-9796
  • Fax: 507-687-7494
Mailing address:
  • Phone: 651-895-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: