Provider Demographics
NPI:1114786639
Name:BRAINERD LAKES AREA PSYCHIATRY LLC
Entity Type:Organization
Organization Name:BRAINERD LAKES AREA PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TWILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP, FNP, PMHNP
Authorized Official - Phone:218-513-6300
Mailing Address - Street 1:7636 DESIGN RD STE 125A
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8693
Mailing Address - Country:US
Mailing Address - Phone:218-513-6300
Mailing Address - Fax:
Practice Address - Street 1:7636 DESIGN RD STE 125A
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8693
Practice Address - Country:US
Practice Address - Phone:218-513-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health