Healthcare Provider Details

I. General information

NPI: 1114786639
Provider Name (Legal Business Name): BRAINERD LAKES AREA PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 THIESSE RD
BRAINERD MN
56401-6532
US

IV. Provider business mailing address

1024 THIESSE RD
BRAINERD MN
56401-6532
US

V. Phone/Fax

Practice location:
  • Phone: 218-513-6300
  • Fax:
Mailing address:
  • Phone: 218-245-4118
  • Fax: 218-454-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TWYLA BATYA
Title or Position: MEDICAL DIRECTOR
Credential: APRN-CNP, FNP, PMHNP
Phone: 218-245-4118