Healthcare Provider Details

I. General information

NPI: 1154253243
Provider Name (Legal Business Name): MIKAYLA BAKER THORN LPCC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIKAYLA BAKER

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 OSBORNE RD NE
FRIDLEY MN
55432-2718
US

IV. Provider business mailing address

3064 JANSEN AVE NE
SAINT MICHAEL MN
55376-7520
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-4569
  • Fax:
Mailing address:
  • Phone: 763-236-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number307010
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5626
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: