NPIMap

Organization Active NPI

Grand Lake Mental Health Center Inc

Doing business as GRAND Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ponca City, OK
National Provider Identifier
1043842370
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
GRAND LAKE MENTAL HEALTH CENTER INC
Doing business as
GRAND Mental Health
Practice address
407 W South Ave
Ponca City, OK 74601-6133
Phone
(580) 308-5515
Fax
(580) 749-5792
NPI assigned
Feb 5, 2020
Last updated
Jun 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Larry SmithNPI 1699217091
Title
Ceo
Phone
(918) 273-1841

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

407 W South Ave
Ponca City, OK 74601-6133

Mailing address

114 W Delaware Ave
Nowata, OK 74048-2601
Phone (918) 273-1841

Other names 1

  • GRAND Mental Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grand Lake Mental Health Center Inc106 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Locations

114 W Delaware Ave
Nowata, OK 74048
Phone 91827318412207

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655078400000",
    "number": "1043842370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 W DELAWARE AVE",
            "city": "NOWATA",
            "state": "OK",
            "postal_code": "740482601",
            "telephone_number": "918-273-1841",
            "fax_number": "918-273-1843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 W SOUTH AVE",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746016133",
            "telephone_number": "580-308-5515",
            "fax_number": "580-749-5792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE MENTAL HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-05",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-273-1841"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRAND Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponca City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.