Healthcare Provider Details

I. General information

NPI: 1265361885
Provider Name (Legal Business Name): CHRISTA LACHELL DYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTA LACHELL

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 LAKE ST S
FOREST LAKE MN
55025-2639
US

IV. Provider business mailing address

15225 FANNING DR N
HUGO MN
55038-6307
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-4792
  • Fax:
Mailing address:
  • Phone: 708-949-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: