Grand Lake Mental Health Center, Inc
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Chouteau, OK
NPI 1376173443 · NPPES record last updated Jun 13, 2022
Key facts
- NPI
- 1376173443
- 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
- 101 N McCracken St
Chouteau, OK 74337-3219 - Phone
- (918) 373-9800
- Fax
- (918) 999-0109
- NPI assigned
- Jan 17, 2020
- 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 11
-
Caroline Graham, DO
-
Kelly Rae Lesley, M.S.
-
Melinda Adrienn Murphy, MS, LPC-S, NCC
-
Haley Jordan Nunn, MS, LPC
-
Angela Sibeso Ogunbase, LADC/MH
-
Tiffany Nicole Tottress, MSW, 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
101 N McCracken St
Chouteau, OK 74337-3219
Mailing address
114 W Delaware Ave
Nowata, OK 74048-2601
Phone (918) 273-1841
Other names
- GRAND Mental Health
Other providers in Chouteau, OK
- Brenda Alice Cunningham
- Johnny Daryel Cunningham
- Lance F. Dickison
- Bradley Alan Duplantis
- Robert E Fox Jr.
- Grand Lake Mental Health Center, Inc.
- Grand Lake Mental Health Center, Inc.
- Chandra Hayes
- Joshua Tyler Hester
- Kaitlin Kozlowski
All providers in Chouteau, 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 13, 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.