NPIMap

Organization Active NPI

Grand Lake Mental Health Center, Inc.

Doing business as GRAND Mental Health

  • Community/Behavioral Health Agency
  • Tulsa, OK
National Provider Identifier
1841444700
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
GRAND LAKE MENTAL HEALTH CENTER, INC.
Doing business as
GRAND Mental Health
Practice address
6333 E Skelly Dr
Tulsa, OK 74135-6106
Phone
(918) 664-4224
Fax
(918) 663-0203
NPI assigned
Nov 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

6333 E Skelly Dr
Tulsa, OK 74135-6106

Mailing address

6333 E Skelly Dr
Tulsa, OK 74135-6106
Phone (918) 664-4224

Other practice location 1

1214 S Baltimore Ave
Tulsa, OK 74119-2804
Phone (918) 664-4224

Other identifiers 1

IdentifierTypeStateIssuer
100737580AMedicaidOK

Other names 2

  • GRAND Mental Health Doing business as
  • 12 & 12, Inc Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
12 12 Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6333 E Skelly Dr
Tulsa, OK 74135
Phone (918) 644-4224

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": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1841444700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 E SKELLY DR",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741356106",
            "telephone_number": "918-664-4224",
            "fax_number": "918-663-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 E SKELLY DR",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741356106",
            "telephone_number": "918-664-4224",
            "fax_number": "918-663-0203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1214 S Baltimore Ave",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741192804",
            "country_code": "US",
            "telephone_number": "918-664-4224",
            "fax_number": "918-663-0203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRAND LAKE MENTAL HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "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": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100737580A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRAND Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "12 & 12, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "12 & 12, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.