Provider Demographics
NPI:1265105092
Name:BEISE, BRIANNA LYNN
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LYNN
Last Name:BEISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 10TH ST NW STE 2
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-1737
Mailing Address - Country:US
Mailing Address - Phone:320-983-2335
Mailing Address - Fax:
Practice Address - Street 1:150 10TH ST NW STE 2
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-1737
Practice Address - Country:US
Practice Address - Phone:320-983-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2024-09-11
Deactivation Date:2024-08-20
Deactivation Code:
Reactivation Date:2024-09-04
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MN301901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician