# GRAND LAKE MENTAL HEALTH CENTER, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Grand Lake Medical Health Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316955198
- **Authorized official:** LARRY SMITH (CEO)
- **Authorized official phone:** (918) 273-1841

## Contact information

- **Practice address:** 17599 S HIGHWAY 88, CLAREMORE, OK 74017-0801
- **Practice address phone:** (918) 273-1841
- **Practice address fax:** (918) 273-1843
- **Mailing address:** 114 W DELAWARE AVE, NOWATA, OK 74048-2601
- **Mailing address phone:** (918) 273-1841
- **Mailing address fax:** (918) 273-1841

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 08/04/2006
- **Last updated:** 07/31/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100732860C | — | OK |