Grand Lake Mental Health Center Inc.
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Kansas, OK
NPI 1295084531 · NPPES record last updated Mar 7, 2024
Key facts
- NPI
- 1295084531
- 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
- 191 N Highway 59
Kansas, OK 74347-7607 - Phone
- (918) 308-5518
- Fax
- (918) 999-0112
- NPI assigned
- Aug 31, 2012
- Organization subpart
- No
Authorized official
- Name
- Larry Smith
- Title
- Ceo
- Phone
- (918) 273-1841
Other NPIs on the same Medicare enrollment 44
Corporate family (same tax ID) 24
Practitioners 23
-
Madison Bailee Green, LPC
-
Erin Johnson, LPC
-
David Leroy McElwain, M.D.
-
Kyle Morrison, BS, BHCM II, BHWC
-
Deaira Puentes Soto, MS, NCC, LPC
-
Brittany Pieke, LPC20731
-
Deanne Hutchinson, BHCM II/BHWC
-
Catherine Shanon Maddan, LMSW-P U/S
-
Kelby Nicole Morgan, BA, CMII
-
Krystal N Vasquez, MS, LPC
-
Gregory Jones, LPC
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
17599 S Highway 88
Claremore, OK 74017
Phone (918) 342-9530
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
191 N Highway 59
Kansas, OK 74347-7607
Mailing address
114 W Delaware Ave
Nowata, OK 74048-2601
Phone (918) 308-5518
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100732860L | Medicaid | OK |
Other names
- GRAND Mental Health
Other providers in Kansas, OK
- Sarah Elizabeth Ellis
- Alexis Fitts
- Meagan Floyd
- Theresa-Grace Gibbins
- Taylor J Goodwin
- Grand Lake Mental Health Center, Inc.
- Grand Lake Mental Health Center, Inc.
- Grand Lake Mental Health Center, Inc.
- Leslie Gregory
- Stacy Johnson
All providers in Kansas, 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 7, 2024. 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.