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
LARRY SMITH (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
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
(918) 663-0203
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100737580A
—
OK
Enumeration date
11/05/2008
Last updated
06/07/2022
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