Healthcare Provider Details

I. General information

NPI: 1285557645
Provider Name (Legal Business Name): CHRISTINA LORY BRASEL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 90TH ST NE STE 203
OTSEGO MN
55330-7465
US

IV. Provider business mailing address

446 SHANNON DR
BIG LAKE MN
55309-3310
US

V. Phone/Fax

Practice location:
  • Phone: 763-777-9499
  • Fax:
Mailing address:
  • Phone: 763-477-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3187
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: