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General NPI Number Information
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NPI Number | 1114786639
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Entity Type | Organization
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Legal Business Name | BRAINERD LAKES AREA PSYCHIATRY LLC
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 1024 THIESSE RD
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City | BRAINERD
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State | MN
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Zip | 56401-6532
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Country | US
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Telephone | 218-513-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 1024 THIESSE RD
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City | BRAINERD
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State | MN
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Zip | 56401-6532
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Country | US
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Telephone | 218-245-4118
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Fax | 218-454-0710
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | TWYLA BATYA
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Credential | APRN-CNP, FNP, PMHNP
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Telephone | 218-245-4118
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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