Organization
GRAND LAKE MENTAL HEALTH CENTER INC
Active
Other names
GRAND Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY SMITH (CEO)
(918) 273-1841
Entity
Organization
Contact information
Practice address
407 W SOUTH AVE, PONCA CITY, OK 74601-6133
(580) 308-5515
(580) 749-5792
Mailing address
114 W DELAWARE AVE, NOWATA, OK 74048-2601
(918) 273-1841
(918) 273-1843
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
02/05/2020
Last updated
06/13/2022
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