Organization
GRAND LAKE MENTAL HEALTH CENTER, INC.
Active
Other names
GRAND Mental Health, 12&12 Inc Outpatient Services
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY SMITH (CEO)
(918) 273-1841
Entity
Organization
Contact information
Practice address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
(918) 664-8732
Mailing address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
(918) 664-8732
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100737580A
—
OK
Enumeration date
02/26/2016
Last updated
06/07/2022
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