Grand Lake Mental Health Center, Inc.
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Perry, OK
NPI 1336707256 · NPPES record last updated Jun 7, 2022
Key facts
- NPI
- 1336707256
- 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
- 502 N 14TH St
Perry, OK 73077-5022 - Phone
- (918) 305-5512
- Fax
- (580) 215-5767
- NPI assigned
- Jun 5, 2019
- 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 4
-
Shemaiah Davis, LPC
-
Sophia Lefrere, LCSW
-
Alyson Nicole Speers, LCSW
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
502 N 14TH St
Perry, OK 73077-5022
Mailing address
114 W Delaware Ave
Nowata, OK 74048-2601
Phone (918) 273-1841
Other names
- GRAND Mental Health
Other providers in Perry, OK
- Foster Corner Drug Inc
- Foster Corner Drug Long Term Care
- Foster Specialty
- Ashley Lynn Garner
- Grand Lake Mental Health Center, Inc.
- Michael Dean Hartwig
- Jana M Hodge
- James L Knecht D.O., Inc.
- Whitney James
- Eldon Lawrence Johnson
All providers in Perry, 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 Jun 7, 2022. 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.