Provider Demographics
NPI:1689013336
Name:NEWSTROM, NICHOLAS PRAKASH (LMFT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:PRAKASH
Last Name:NEWSTROM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18141 FRESNO ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1714
Mailing Address - Country:US
Mailing Address - Phone:763-370-8619
Mailing Address - Fax:
Practice Address - Street 1:17717 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4148
Practice Address - Country:US
Practice Address - Phone:952-936-0304
Practice Address - Fax:952-936-0454
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist