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General NPI Number Information
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NPI Number | 1477740918
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Entity Type | Individual
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Provider Name | NATASHA DEETT BRASETH LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 1500 30TH AVE S STE C
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City | MOORHEAD
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State | MN
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Zip | 56560-5146
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Country | US
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Telephone | 218-451-3614
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Fax | 218-512-0685
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Provider Business Mailing Address
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Address Line | PO BOX 2010
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City | FARGO
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State | ND
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Zip | 58122-0001
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Country | US
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Telephone | 701-417-6785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23765
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4612
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License Number State | ND
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