Grand Lake Mental Health Center Inc
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Claremore, OK
NPI 1134539141 · NPPES record last updated Mar 30, 2021
Key facts
- NPI
- 1134539141
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- GRAND LAKE MENTAL HEALTH CENTER INC
- Practice address
- 3100 Medical Pkwy
Claremore, OK 74017-1088 - Phone
- (918) 342-0770
- Fax
- (918) 342-0087
- NPI assigned
- Apr 29, 2014
- Organization subpart
- No
Authorized official
- Name
- Mr. Larry Smith
- Title
- Ceo
- Phone
- (918) 273-1841
Other NPIs on the same Medicare enrollment 44
Corporate family (same tax ID) 24
Practitioners 10
-
Alishia Butler, MCP, LADC-MH
-
Gretchen Louise Davis, LCSW
-
Eldon Lawrence Johnson, M.ED., LPC.
-
Christian Lynn Peters, LCSW
-
Kilie S Hamm, LPC- CANDIDATE
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091026000174 | OK | Part B Supplier - Clinic/Group Practice | 4688711534 |
Receives reassigned benefits from 341 practitioners 44 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Pawhuska, OK; Perry, OK; Ponca City, OK; Pryor, OK; Skiatook, OK; Stillwater, OK; Claremore, OK; Tulsa, OK… |
National Provider Directory
- Tax ID family
- Grand Lake Mental Health Center Inc
Locations
111 S Treaty Rd
Miami, OK 74354
Phone (918) 540-1511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
3100 Medical Pkwy
Claremore, OK 74017-1088
Mailing address
114 W Delaware Ave
Nowata, OK 74048-2601
Phone (918) 273-1841
Other names
- Grand Lake Medical Health Center
Other providers in Claremore, OK
- Kennedy Nicole Goodnight
- Bailey Goodpaster
- Omobola Gordon
- Elizabeth Charlotte Gourley
- Debbie Grace
- Grand Lake Mental Health Center Inc
- Grand Lake Mental Health Center Inc
- Grand Lake Mental Health Center, Inc
- Grand Lake Mental Health Center, Inc.
- Grand Lake Mental Health Center, Inc.
All providers in Claremore, OK · Mental Health Clinic/Center (Including Community Mental Health Center) in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.