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
191 N HIGHWAY 59, KANSAS, OK 74347-7607
(918) 308-5518
(918) 999-0112
Mailing address
114 W DELAWARE AVE, NOWATA, OK 74048-2601
(918) 308-5518
(918) 999-0112
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100732860L
—
OK
Enumeration date
08/31/2012
Last updated
03/07/2024
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