Provider Demographics
NPI:1477740918
Name:BRASETH, NATASHA DEETT (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:NATASHA
Middle Name:DEETT
Last Name:BRASETH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-0001
Mailing Address - Country:US
Mailing Address - Phone:701-417-6785
Mailing Address - Fax:
Practice Address - Street 1:1500 30TH AVE S STE C
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5146
Practice Address - Country:US
Practice Address - Phone:218-451-3614
Practice Address - Fax:218-512-0685
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN237651041C0700X
ND46121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical