Organization
GRAND LAKE MENTAL HEALTH CENTER, INC.
Active
Organization
GRAND LAKE MENTAL HEALTH CENTER, INC.
Active
Other names
12 & 12, Inc, GRAND Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA CANTWELL (CEO)
(918) 273-1841
Entity
Organization
Contact information
Practice address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
(918) 663-0203
Mailing address
114 W DELAWARE AVE, NOWATA, OK 74048-2601
(918) 273-1841
(918) 273-1843
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
640AD
OK
Other
Enumeration date
06/27/2005
Last updated
10/17/2025
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